Dressel

Prior to creating your account, please be sure you have the following documents and information ready:

Personal Data

Basic contact info
Emergency contact number (non-diver)

Dive Info

Approximate date of last dive
Approximate total number of dives

Dive Certification

Dive certification card (digital or physical)
- You can upload a picture or take a picture within the app
Nitrox certification card (if certified)

Documents

Signed doctor’s note if required

CONTACT INFORMATION

First Name:

Last Name:

I go by a different preferred name

Email Address:

Date of Birth:

Phone number:

Password :

Confirm Password :

EMERGENCY CONTACT (not diving with you)

Name:

Phone Number:

Relationship:

UPLOAD PROFILE PICTURE

DIVE CERTIFICATION

Agency :

Agency Name:

Certification number:

Diving Certification level:

My card doesn’t have a backside or I have a digital certification e-card

Front Photo:

Back Photo:

NITROX CERTIFICATION

I am not certified nitrox

Agency:

Agency Name:

Nitrox Certification Number:

My card doesn’t have a backside or I have a digital certification e-card

Front Photo:

Back Photo:

LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT

Please read carefully and fill in all blanks before signing.

I hereby affirm that I am aware that skin and scuba diving have inherent risks which may result in serious injury or death.

I, , understand that diving with compressed air involves certain inherent risks: including but not limited to decompression sickness, embolism or other hyperbaric/air expansion injury that require treatment in a recompression chamber. I further understand that the open water diving trips which are necessary for training and for certification may be conducted at a site that is remote, either by time or distance or both, from such a recompression chamber. I still choose to proceed with such instructional dives in spitee of the possible absence of a recompression chamber in proximity to the dive site.

I, , understand and agree that neither my instructor(s), DRESSEL DIVERS STAFF, nor DRESSEL DIVERS CLUB INTERNATIONAL (also legally known as MANTA DIVERS S.A. in the Dominican Republic, and/or BLUE TANG DIVERS, S.R.L. also in the Dominican Republic, and/or CLUB DE BUCEO PLAYA S.A. DE C.V. in Mexico, and/or AQUATICA MAYA S.A. DE C.V. also in Mexico, and/or AQUATICA LITIBU S de RL de C.V. also in Mexico, and/or SPORTS & DIVER CLUB LTD. in Jamaica), nor INTERNATIONAL PADI, INC., and/or ITI HOLDINGS, LLC (also known as SDI) nor its affiliate and subsidiary corporations, nor any of their respective employees, officers, agents, contractors or assigns (hereinafter referred to as “Released Parties”) may be held liable or responsible in any way for any injury, death or other damages to me, my family, estate, heirs or assigns that may occur as a result of my participation in this diving program or as a result of the negligence of any party, including the Released Parties, whether passive or active.

I, , acknowledge and agree that I have contracted the services referred by this receipt exclusively with Dressel Divers International, therefore I exclude any other person or entity from any legal liability directly or related to such activities. Which I do so under my own will, risk, and under the direct and exclusive dependence of Dressel Divers Club International.

In consideration of being allowed to participate in this course I hereby personally assume all risks of this course, whether foreseen or unforeseen, that may befall me while I am a participant in this course including, but not limited to, the academics, confined water and/or open water activities.

I, , further release, exempt and hold harmless said program and Released Parties from any claim or lawsuit by me, my family, estate, heirs or assigns, arising out of my enrollment and participation in this program including both claims arising during the program or after I receive my certification.

I, , also understand that skin diving and scuba diving are physically strenuous activities and that I will be exerting myself during this program, and that if I am injured as a result of heart attack, panic, hyperventilation, drowning or any other cause, that I expressly assume the risk of said injuries and that I will not hold the Released Parties responsible for the same.

I, , further state that I am of lawful age and legally competent to sign this liability release, or that I have acquired the written consent of my parent or guardian.

I, , understand the terms herein are contractual and not a mere recital, and that I have signed this Agreement of my own free act and with the knowledge that I hereby agree to waive my legal rights. I further agree that if any provision of this Agreement is found to be unenforceable or invalid, that provision shall be severed from this Agreement. The remainder of this Agreement will then be construed as though the un-enforceable provision had never been contained herein.

I, , understand and agree that I am not only giving up my right to sue the Released Parties but also any rights my heirs, assigns, or beneficiaries may have to sue the Released Parties resulting from my death. I further represent I have the authority to do so and that my heirs, assigns, or beneficiaries will be estopped from claiming otherwise because of my representations to the Released Parties.

I, , BY THIS INSTRUMENT AGREE TO EXEMPT AND RELEASE MY INSTRUCTOR(S), DRESSEL DIVERS STAFF , and DRESSEL DIVERS CLUB INTERNATIONAL (also legally known as MANTA DIVERS S.A. in the Dominican Republic, and/or BLUE TANG DIVERS, S.R.L. also in the Dominican Republic, and/or CLUB DE BUCEO PLAYA S.A. DE C.V. in Mexico, and/or AQUATICA MAYA S.A. DE C.V. also in Mexico, and/or AQUATICA LITIBU S de RL de C.V. and/or SPORTS & DIVER CLUB LTD. in Jamaica), INTERNATIONAL PADI, INC., and/or ITI HOLDINGS, LLC (also known as SDI) AND ALL RELATED ENTITIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWEVER CAUSED, INCLUDING BUT NOT LIMITED TO THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE.

I, , HAVE FULLY INFORMED MYSELF AND MY HEIRS OF THE CONTENTS OF THIS LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT BY READING IT BEFORE I SIGNED IT ON BEHALF OF MYSELF AND MY HEIRS.

IN CASE OF DISPUTE AND IN AGREEMENT WITH THIS DISCLAIMER, FOR ALL MATTERS RELATED TO ITS INTERPRETATION, PERFORMANCE, COMPLIANCE, EXECUTION OF THE CONTRACTED ACTIVITIES AND DURING ITS DEVELOPMENT. I AM EXPRESSLY SUBJECT TO THE LAWS AND JURISDICTION OF THE COUNTRY WHERE THIS DOCUMENT HAS BEEN SIGNED, AND EXPRESSLY RENOUNCE ANY OTHER JURISDICTION OR FORUM THAT COULD CORRESPOND TO ME DUE TO MY PRESENT OR FUTURE ADDRESS, NATIONALITY, OR FOR ANY OTHER REASON.

I agree to all the above statements.

e-Signature

1. I have had problems with my lungs, breathing, heart and/or blood affecting my normal physical or mental performance.	Yes	No
Box A - I have/have had:
Chest surgery, heart surgery, heart valve surgery, an implantable medical device (eg, stent, pacemaker, neurostimulator), pneumothorax, and/or chronic lung disease.	Yes	No
Asthma, wheezing, severe allergies, hay fever or congested airways within the last 12 months that limits my physical activity/exercise.	Yes	No
A problem or illness involving my heart such as: angina, chest pain on exertion, heart failure, immersion pulmonary edema, heart attack or stroke, OR am taking medication for any heart condition.	Yes	No
Recurrent bronchitis and currently coughing within the past 12 months, OR have been diagnosed with emphysema.	Yes	No
Symptoms affecting my lungs, breathing, heart and/or blood in the last 30 days that impair my physical or mental performance.	Yes	No
2. I am over 45 years of age.	Yes	No
Box B - I am over 45 years of age AND:
I currently smoke or inhale nicotine by other means.	Yes	No
I have a high cholesterol level.	Yes	No
I have high blood pressure.	Yes	No
I have had a close blood relative die suddenly or of cardiac disease or stroke before the age of 50, OR have a family history of heart disease before age 50 (including abnormal heart rhythms, coronary artery disease or cardiomyopathy).	Yes	No
3. I struggle to perform moderate exercise (for example, walk 1.6 kilometer/one mile in 14 minutes or swim 200 meters/yards without resting), OR I have been unable to participate in a normal physical activity due to fitness or health reasons within the past 12 months.	Yes	No
4.I have had problems with my eyes, ears or nasal passages/sinuses.	Yes	No
Box C - I have/have had:
Sinus surgery within the last 6 months.	Yes	No
Ear disease or ear surgery, hearing loss, or problems with balance.	Yes	No
Recurrent sinusitis within the past 12 months.	Yes	No
Eye surgery within the past 3 months.	Yes	No
5. I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery.	Yes	No
6. I have lost consciousness, had migraine headaches, seizures, stroke, significant head injury or suffer from persistent neurologic injury or disease.	Yes	No
Box D - I have/have had:
Head injury with loss of consciousness within the past 5 years.	Yes	No
Persistent neurologic injury or disease.	Yes	No
Recurring migraine headaches within the past 12 months, or take medications to prevent them.	Yes	No
Blackouts or fainting (full/partial loss of consciousness) within the last 5 years.	Yes	No
Epilepsy, seizures, or convulsions, OR take medications to prevent them.	Yes	No
7. I am currently undergoing treatment (or have required treatment within the last five years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning or developmental disability.	Yes	No
Box E - I have/have had:
Behavioral health, mental or psychological problems requiring medical/psychiatric treatment.	Yes	No
Major depression, suicidal ideation, panic attacks, uncontrolled bipolar disorder requiring medication/psychiatric treatment.	Yes	No
Been diagnosed with a mental health condition or a learning/developmental disorder that requires ongoing care or special accommodation.	Yes	No
An addiction to drugs or alcohol requiring treatment within the last 5 years.	Yes	No
8. I have had back problems, hernia, ulcers, or diabetes.	Yes	No
Box F - I have/have had:
Recurrent back problems in the last 6 months that limit my everyday activity.	Yes	No
Back or spinal surgery within the last 12 months.	Yes	No
Diabetes, drug- or diet-controlled, OR gestational diabetes within the last 12 months.	Yes	No
An uncorrected hernia that limits my physical abilities.	Yes	No
Active or untreated ulcers, problem wounds, or ulcer surgery within the last 6 months.	Yes	No
9. I have had stomach or intestine problems, including recent diarrhea.	Yes	No
Box G - I have had:
Ostomy surgery and do not have medical clearance to swim or engage in physical activity.	Yes	No
Dehydration requiring medical intervention within the last 7 days.	Yes	No
Active or untreated stomach or intestinal ulcers or ulcer surgery within the last 6 months.	Yes	No
Frequent heartburn, regurgitation, or gastrosophageal reflux disease (GERD).	Yes	No
Active or uncontrolled ulcerative colitis or Crohn's disease.	Yes	No
Bariatric surgery within the last 12 months.	Yes	No
10. I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefloquine/Lariam).	Yes	No

Prior to creating your account, please be sure you have the following documents and information ready:

Personal Data

Dive Info

Dive Certification

Documents

CONTACT INFORMATION

EMERGENCY CONTACT (not diving with you)

UPLOAD PROFILE PICTURE

DIVE HISTORY

RENTAL GEAR NEEDED

DIVE CERTIFICATION

NITROX CERTIFICATION

LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT

Please read carefully and fill in all blanks before signing.

Diver Medical | Participant Questionnaire

Directions

Box A - I have/have had:

Box B - I am over 45 years of age AND:

Box C - I have/have had:

Box D - I have/have had:

Box E - I have/have had:

Box F - I have/have had:

Box G - I have had:

e-Signature