NAME____________________________________________ AGE___________________________
(IF UNDER 18)
ADDRESS___________________________________________________________________________

CITY_____________________________ PROVINCE_________ POSTAL CODE_________________

E-MAIL____________________________________________________PHONE___________________

REGISTRATION FEE: $55.00*______________________
NON - DIVER (SUPPER) Price TBA_____________________

TOTAL _____________________

____________________________________________________________________________________

WAIVER:

All dives that you participate in must be within your qualification level. Also it is up to you to remain current. Always dive within your capabilities.

I understand and agree that THE DEPARTMENT OF NATURAL RESOURES, THE MANITOBA UNDERWATER COUNCIL, THE DAUPHIN DOLPHIN SCUBA CLUB, its executive committee members, staffing personnel, and volunteers may not be held liable in any way for any occurrence in connection with this dive club which may result in injury, death or other damages to me or my family. In consideration of being allowed to participate in this club or activities, I hereby personally assume all risks in connection with this organization for any harm, injury or damage which may occur while I am participating in any activities, including without limitation, all risks connected herewith, whether foreseen or unforeseen, whether or not occurring as a result or the negligence of DEPARTMENT OF NATURAL RESOURCES, THE MANITOBA UNDERWATER COUNCIL, THE DAUPHIN SCUBA CLUB, its executive committee members, planning committee members, staffing personnel and volunteers.

I further state that I am of lawful age and legally competent to sign this affirmation and release, or that I have acquired the written consent of my parents or guardians; that I understand the terms herein are contractual and not a mere recital; and that I have signed this document on my own free act. IT IS MY INTENTION BY THIS INSTRUMENT TO EXCEPT AND RELEASE DEPARTMENT OF NATURAL RESOURCES, THE MANITOBA UNDEERWATER COUNCIL, THE DAUPHIN DOLPHIN SCUBA CLUB, its executive committee members, planning committee members, staffing personnel and volunteers from all liability whatsoever for personal injury, property damage or wrongful death arising out of the negligence of THE DEPARTMENT OF NATURAL RESOURCES, THE MANITOBA UNDERWATER COUNCIL, THE DAUPHIN DOLPHIN SCUBA CLUB, its executive committee members, staffing personnel and volunteers. I acknowledge that I have read, had explained to me and understand this statement before signing it. I verify that I am physically fit, not under the influence of alcohol or drugs at this time and sufficiently qualified to participate in this event.

_____________________________________ ________________________________
PARTICIPANT/ MEMBER SIGNATURE DATE

__________________________________________________ _______________________________
PARENT/GAURDIAN SIGNATURE (IF UNDER 18YEARS) WITNESS

MAIL REGISTRATIONS TO: DAUPHIN DOLPHIN SCUBA CLUB
BOX 398
DAUPHIN, MB
R7N 2V2
PHONE 1-204-638-1804
Email: robrah@mts.net