sdi instructor manual part 5

SDI Instructor Manual

Part 5

Appendix Forms

All Rights Reserved, 1999 © By Scuba Diving International (SDI)

Copyright 1999 © by Scuba Diving International (SDI).

All rights reserved. Printed in the United States of America. Except as permitted under the Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or

retrieval system, without the prior written permission of the publisher.

Scuba Diving International 18 Elm Street, Topsham, ME 04086

Phone: 207-729-4201 Toll Free: 888-778-9073 Fax: 207-729-4453

Web site: www.tdisdi.com

E-mail: [email protected]

Business hours: Monday - Friday, 8:00 AM to 6:00 PM Eastern time

SDI Instructor Manual Part 5 – Appendix

Date: 11/19/04Revision: 5.0

Table of Contents

1. SDI Forms Overview ........................................................................................... iii 1.1 SDI – Scuba Diver Registration Form ............................................................................................iii 1.2 SDI – Medical Information Form.....................................................................................................iii 1.3 SDI – General Liability Release And Express Assumption Of Risk Forms....................................iii 1.4 SDI – Divemaster or Assistant Instructor Registration Form .........................................................iii 1.5 SDI – Scuba Diving Instructor Registration Form ..........................................................................iv 1.6 SDI – Specialty Upgrade Form for Instructors ...............................................................................iv 1.7 SDI – Open Water Global Referral Form .......................................................................................iv 1.8 SDI – Solo Release Form...............................................................................................................iv 1.9 SDI – Accident / Incident Report Form...........................................................................................iv 1.10 SDI – Academic Presentation Form...............................................................................................iv 1.11 SDI – In-Water Presentation Form.................................................................................................iv

2. Forms .................................................................................................................... 1

SDI Instructor Manual - Part 5.doc

Index i of iv



Revision History

Revision Number Date Sections Changed 2.0 05/27/01 The Manual has been completely restructured and

updated to reflect latest changes and additions. 2.1 10/10/02 Updated with latest Training Updates. 3.0 08/15/03 Updated with latest Training Updates. 3.1 12/23/03 2004 Renewal update. 5.0 11/19/04 Major update, changes on most forms.


Index ii of iv



1. SDI Forms Overview

1.1 SDI – Scuba Diver Registration Form Use this form for the following 1. Open Water Scuba Diver 2. Junior Open Water Scuba Diver 3. Advanced Scuba Diver 4. Master Scuba Diver 5. CPROX Administrator 6. Rescue Diver 7. Specialty (Remember to specify which specialty)

1.2 SDI – Medical Information Form Use this form to obtain medical information from the Students. Make sure to review the contents before

starting on a course or specialty.

1.3 SDI – General Liability Release And Express Assumption Of Risk Forms

Use this form to obtain the General Liability Release from the Students. Make sure to review the contents before starting on a course or specialty to ensure it has been completed and signed – including the signature of a witness. ONE FORM PER COURSE.

1. General Liability Release And Express Assumption Of Risk – for Teaching 2. General Liability Release And Express Assumption Of Risk - For Guided Scuba Tours For

Certified Divers 3. General Liability Release And Express Assumption Of Risk - For Guided Snorkeling Tours 4. General Liability Release And Express Assumption Of Risk - For Unguided & Unsupervised Boat

Dives For Certified Divers

1.4 SDI – Divemaster or Assistant Instructor Registration Form Use this form to file for Divemaster or Assistant Instructor rating.


Index iii of iv




Index iv of iv

1.5 SDI – Scuba Diving Instructor Registration Form Use this form to file for Instructor rating.

1.6 SDI – Specialty Upgrade Form for Instructors Use this form to file for specialty upgrades – for Instructors ONLY.

1.7 SDI – Open Water Global Referral Form Use this form to when a student is traveling to another facility for the Open Water certification. The

procedure is covered in Part 2 – Open Water Instructor Manual.

1.8 SDI – Solo Release Form Use this form as the Solo Diver Liability Release.

1.9 SDI – Accident / Incident Report Form Use this form to file information regarding an accident or incident with SDI Headquarter.

1.10 SDI – Academic Presentation Form Use this form when preparing for the academic portion of a class. An example of its usage can be found in

the Academic portion of the Open Water Instructor Manual.

1.11 SDI – In-Water Presentation Form Use this form when preparing for the confined portion of a class. An example of its usage can be found in

the In-Water portion of the Open Water Instructor Manual.

2. Forms

Scuba Diver Registration Form

18 Elm St, Topsham, Maine 04086 Phone: 207-729-4201 Fax: 207-729-4453

Method of Payment

AMEX , MasterCard , Visa , Check or Money Order (Make Checks Payable to SDI)

Exp. Date: Signature:

Course: Check only ONE course per diver registration form

Open Water Scuba Diver Junior Open Water Scuba Diver Advanced Scuba Diver Rescue Diver Specialty (Please specify): Master Scuba Diver

CERTIFICATION FEE: C-Card Only* C-Card & Certificate* All diver c-cards & certificates are sent directly to the instructor or facility

Print Name as it is to appear on C-Card

Complete Mailing Address (include City, State and Zip Code)

Phone Number E-mail Address

Course Completion Date (mm/dd/yy): 2nd Inst./Asst. by: #:

Freshwater Max training depth: Saltwater (Meter / feet):

Facility Name:

Instructor Name: Facility Number:

Instructor’s SDI #:

Instructor Phone #:

Instructor Address:

Ship To Address:

City:

State:

Zip (or postal code):

I certify that the above named students have completed the SDI training course indicated and have reached the proficiency level required by SDI Standards before issuing these certifications. In addition, I agree to void all cards not issued within six months.

Instructor Signature (Required on each Form) Date Signed Country:

Copyright © 2002 by Scuba Diving International (SDI) Revision 5.0, 11/29/04

Scuba Diving International Medical Statement

Participant Record (Confidential Information)

18 Elm Street, Topsham, Maine 04086

Phone: (207) 729-4201 Fax: (207) 729-4453

---- Please read carefully before signing ---- This is a statement in which you are informed of some potential risks involved in scuba diving and of the conduct required of you during the scuba-training program. Your signature on this statement is required for you to participate in the scuba training program offered by _____________________________________ and Instructor ______________________________ located in the Facility City of ____________________ and State of _______ Read and discuss this statement prior to signing it. You must complete this Medical Statement, which includes the medical-history section, to enroll in the scuba-training program. If you are a minor, you must have this statement signed by a parent. Diving is an exciting and demanding activity. When performed correctly, applying correct techniques, it is very safe.

When established safety procedures are not followed, however, there are dangers. To scuba dive safely, you must not be extremely overweight or out of condition. Diving can be strenuous under certain conditions. Your respiratory and circulatory systems must be in good health. All body air spaces must be normal and healthy. A person with heart trouble, a current cold or congestion, epilepsy, asthma, a severe medical problem or who is under the influence of alcohol or drugs should not dive. If taking medication, consult your doctor and the instructor before participation in this program. You will also need to learn from the instructor the important safety rules regarding breathing and equalization while scuba diving. Improper use of scuba equipment can result in serious injury. You must be thoroughly instructed in its use under direct supervision of a qualified instructor to use it safely. If you have any additional questions regarding this Medical Statement or the Medical History section, review them with your instructor before signing.

MEDICAL HISTORY - To the Participant The purpose of this medical questionnaire is to find out if your doctor should examine you before participating in recreational dive training. A positive response to a question does not necessarily disqualify you from diving. A positive response means that there is a preexisting condition that may affect your safety while diving and you must seek the advice of your physician. Please answer EACH ONE the following questions on your past or present medical history with a YES or NO. If you are not sure, answer YES. If any of those items apply to you, we must request that you consult with a physician prior to participating in scuba diving.

___ Are you pregnant? Have you ever had or do you currently have: ___ Do you have active asthma or history of emphysema or

tuberculosis? ___ Frequent or severe attacks of hay fever or allergy? ___ Do you currently have a cold, sinusitis or bronchitis? ___ Any form of lung disease? ___ Have you had a Pneumothorax (collapsed lung)? ___ History of chest surgery? ___ Claustrophobia or agoraphobia (fear of closed or open

spaces)? ___ Epilepsy, seizures, convulsions or take medications to

prevent them? ___ Recurring migraine headaches or take medications to

prevent them? ___ Do you have a history of diabetes? ___ History of blackouts or fainting (full/partial loss of

consciousness)?

___ History of diving accidents or decompression sickness? ___ History of recurrent back problems? ___ History of back surgery? ___ Inability to perform moderate exercise (example: walk one

mile within 12 minutes)? ___ History of high blood pressure or take medicine to control

blood pressure? ___ History of any heart disease? ___ History of heart attacks? ___ Angina or heart surgery or blood vessel surgery? ___ History of ear disease, hearing loss or problems with

balance? ___ History of drug or alcohol abuse? ___ Do you currently have an ear infection? ___ Are you currently taking medication that carries a warning

about any impairment of your physical or mental abilities? ___ Do you have a history of bleeding or other blood

disorders? ___ Any other current medical condition that you feel could

contradict participation in an active demanding sport such as scuba diving?

The information I have provided about my medical history is accurate to the best of my knowledge. ________________________________________________ _________________ Signature Date ________________________________________________ _________________ Signatures of Parents or Guardians (Where Applicable) Date


STUDENT Please print legibly

Name:______________________________________________________ Birth Date:____________ Age:______ First Initial Last Mailing Address:_____________________________________________________________________________

_____________________________________________________________________________ City:___________________________________________ State/ Province:_______________________________ Country:_______________________________________ Zip / Postal Code:______________________________ Phone: (_______)_______________________________ Fax: (_______)_________________________________

Name and address of your family or primary care physician Physician:__________________________________________ Clinic/ Hospital:___________________________ Address:____________________________________________________________________________________ City State Zip Phone: (____)______________________________________ Date of last physical examination: ____ /____/____ mm / dd / yy Name of examiner:__________________________________ Clinic/ Hospital:____________________________ Address:_____________________________________________________ Phone: (______)_________________ Were you ever required to have a physical for diving? Yes No If so, when? _________________________

PHYSICIAN This person is an applicant for training or is presently certified to engage in scuba (self contained underwater breathing apparatus) diving. Your opinion of the applicant’s medical fitness for scuba diving is requested. Physician’s impression: ____ I find no medical conditions that I consider incompatible with diving. ____ I am unable to recommend this individual for diving. Remarks: __________________________________________________________________________________ __________________________________________________________________________________ Physician:___________________________________________ Clinic/ Hospital:__________________________ Address:____________________________________________________________________________________ City State Zip Phone: (________)__________________________ Fax: (________)________________________________ Physician's Signature:_______________________________________________ Date ______/______/______ mm / dd / yy

International Training, Inc.● 18 Elm Street ● Topsham ME 04086 Phone: (207) 729-4201● Fax: (207) 729-4453


General Liability Release And Express Assumption Of Risk


Phone: (207) 729-4201 Fax: (207) 729-4453

For _____________________________________________ (specify Course or Specialty) training program under sanction through SDI. Please read carefully, fill in all blanks and initial each paragraph before signing at bottom.

I, ______________________________, hereby affirm that I have been advised and thoroughly informed of the inherent hazards of scuba diving activities

________ Further, I understand that diving with compressed air or oxygen enriched air (nitrox) involves certain inherent risks including decompression sickness, embolism, oxygen toxicity, inert gas narcosis, marine life injuries or other barotrauma/hyperbaric injuries can occur that require treatment in a recompression chamber. I further understand that the open water diving trips, which are necessary for training and certification, may be conducted at a site that is remote, either by time of distance or both, from such a recompression chamber. I still choose to proceed with such instructional dives in spite of the possible absence of a recompression chamber in proximity to the dive site.

________ I understand and agree that neither my Instructor(s) ___________________________________, the facility through which I received my Instruction, ________________________________________, International Training and Scuba Diving International, nor the officers, directors, shareholders, affiliated companies, employees, agents, or assigns of the above listed entities and/or individuals, nor the authors of any materials including texts and tables expressly used for training and certification (hereinafter referred to as "Released Parties") may be held liable or responsible in any way for any injury, death, or other damages to me or my family, heirs, or assigns that may occur as a result of my participation in this diving class or as a result of the negligence of any party, including the Released Parties, whether passive or active.

________ In consideration of being allowed to enroll in this course, I hereby personally assume all risks in connection with said course, for any harm, injury, or damage that may befall me while I am enrolled as a student of this course, including all risks connected therewith, whether foreseen or unforeseen.

________ I further agree to save, defend, indemnify, and hold harmless said course and Released Parties from any claim or lawsuit by me, anyone purporting to act on my behalf, my family, estate, heirs or assigns, arising directly or indirectly out of my enrollment and participation in this course including both claims arising during the course or after I receive my certification even if such claims may be groundless, false or fraudulent.

________ I also understand that diving activities are physically strenuous and that I will be exerting myself during this diving course, and that if I am injured as a result of heart attack, panic, hyperventilation, oxygen toxicity, inert gas narcosis, drowning, etc. that I expressly assume the risk of said injuries and that I will not hold the above listed individuals or companies responsible for the same, and I agree to defend, indemnify, and hold harmless said course and Released Parties for any such injuries incurred by me.

________ I understand that these activities may place me deeper than I am able to safely execute a free (without breathing gas) ascent from.

________ I understand that I may be required to furnish my own equipment and that I am responsible for its operating condition and maintenance.

________ 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 that the terms herein are contractual and not a mere recital, and that I have signed this document of my own free act. Further that I understand and agree that, in the event that one or more of the provisions of this agreement, for any reason, is held by a court of competent jurisdiction to be invalid or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect any other provision hereof, and this agreement shall be construed as if such invalid, illegal or unenforceable provision or provisions had never been contained herein.

IT IS THE INTENTION OF ____________________________________ BY THIS INSTRUMENT TO EXEMPT AND RELEASE MY INSTRUCTORS, _________________________ (AND OTHERS, _________________________), THE FACILITY THROUGH WHICH I RECEIVED MY INSTRUCTION ______________________________, THE TRAINING AGENCY _________________________ AND INTERNATIONAL TRAINING INC. AND SCUBA DIVING INTERNATIONAL, AND ALL OTHER RELATED ENTITIES AND RELEASED PARTIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWEVER CAUSED, OR ARISING OUT OF, DIRECTLY OR INDIRECTLY, INCLUDING, BUT NOT LIMITED TO, THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND EXPRESS ASSUMPTION OF RISK BY READING IT BEFORE SIGNING IT ON BEHALF OF MYSELF AND MY HEIRS.

This document is required for all courses and Specialties taught under sanction by Scuba Diving International. No alterations, changes, omissions or revisions may be made.

_______________________________ ___________________________ Signature of Student/Participant / Date Signatures of Parents or Guardians / Date (where applicable) _______________________________ Witness / Date

Copyright© 2002 by Scuba Diving International (SDI) Revision 5.0, 11/29/04



Phone: (207) 729-4201 Fax: (207) 729-4453

For Guided Scuba Tours For Certified Divers Please read carefully, fill in all blanks and initial each paragraph before signing at bottom.

I, ______________________________, hereby affirm that I have been advised and thoroughly informed of the inherent hazards of scuba diving activities and participation in a guided tour as a diver.

________ Further, I understand that diving with compressed air, oxygen enriched air (Nitrox), and trimix supplied by standard open circuit scuba

or with semi-closed circuit or closed circuit rebreathers involves certain inherent risks including decompression sickness, embolism, oxygen toxicity, inert gas narcosis, hypoxia, hypercapnia, marine life injuries or other barotrauma or hyperbaric injuries. Such injuries can occur that require treatment in a recompression chamber or medical facility. I further understand that dive activities can be at remote sites, and isolated by time and distance, from such a recompression chamber or medical facility. I still choose to proceed with such dives in spite of the absence of a recompression chamber in proximity to the dive site.

________ I understand and agree that neither the instructor/guide ___________________________________, nor any of the respective employees, officers, agents or assigns of ________________________________________, (hereinafter referred to as "Released Parties") may be held liable or responsible in any way for any injury, death, or other damages to me or my family, heirs, or assigns that may occur as a result of my participation in this diving activity or as a result of the negligence of any party, including the Released Parties, whether passive or active.

________ In consideration of being allowed to participate in this activity I hereby personally assume all risks in connection with said trip, for any harm, injury, or damage that may befall me while I am a diving participant including all risks connected therewith, whether foreseen or unforeseen.

________ I further agree to save, defend, indemnify, and hold harmless said Released Parties from any claim or lawsuit by me, anyone purporting to act on my behalf, my family, estate, heirs or assigns, arising directly or indirectly out of my participation and diving activities including claims arising during this activity even if such claims may be groundless, false or fraudulent.

________ I also understand that diving activities are physically strenuous and that I will be exerting myself during this diving trip and that if I am injured as a result of heart attack, panic, hyperventilation, oxygen toxicity, inert gas narcosis, drowning, etc. that I expressly assume the risk of said injuries and that I will not hold the above listed individuals or companies responsible for the same, and I agree to defend, indemnify, and hold harmless said Released Parties for any such injuries incurred by me.

________ I understand that these activities may place me deeper than I am able to safely execute a free ascent (without breathing gas)from. ________ I understand that I may be required to furnish some of my own equipment and that I am responsible for its operating condition and

maintenance. ________ I understand that I may be supplied with certain items of scuba equipment and that I am responsible for reviewing its proper function

and operating condition prior to using it. ________ 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 further state that I am already a qualified and certified scuba diver from the following training agencies: ______________________,

and that I hold training to the level of ________________________. I am aware of the required certification level and/or experience necessary and recommended to enroll in this diving activity and I stipulate that I meet requirements for prior certification or equivalent experience. I have been a certified diver since ______ and have been diving for _____ years for a total of ______ dives to a maximum depth of ____ ft.

_______ I understand that the terms herein are contractual and not a mere recital, and that I have signed this document of my own free act. Further that I understand and agree that, in the event that one or more of the provisions of this agreement, for any reason, is held by a court of competent jurisdiction to be invalid or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect any other provision hereof, and this agreement shall be construed as if such invalid, illegal or unenforceable provision or provisions had never been contained herein.

IT IS THE INTENTION OF ____________________________________ BY THIS INSTRUMENT TO EXEMPT AND RELEASE MY INSTRUCTORS DIVEMASTER/GUIDE, _________________________ THE BUSINESS, _________________________), AND ALL OTHER RELATED ENTITIES AND RELEASED PARTIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWEVER CAUSED, OR ARISING OUT OF, DIRECTLY OR INDIRECTLY, INCLUDING, BUT NOT LIMITED TO, THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND EXPRESS ASSUMPTION OF RISK BY READING IT BEFORE SIGNING IT ON BEHALF OF MYSELF AND MY HEIRS.





Phone: (207) 729-4201 Fax: (207) 729-4453

For Guided Snorkeling Tours Please read carefully, fill in all blanks and initial each paragraph before signing at bottom.

I, ______________________________, hereby affirm that I have been advised and thoroughly informed of the inherent hazards of snorkeling activities and participation in a guided tour as a snorkeler.

________ Further, I understand that snorkeling involves certain inherent risks including marine life injuries, drowning, slipping & falling on either

a vessel or a beach entry point, possible hazards from other watercraft or vessels in the area or other barotrauma injuries such as ear or mask squeezes, etc. Such injuries can occur that may require treatment in a medical facility. I further understand that snorkeling activities can be at remote sites, and isolated by time and distance, from such a medical facility. I still choose to proceed with such snorkeling activities in spite of the absence of a medical facility in proximity to the snorkeling site.

________ I understand and agree that neither the instructor/guide ___________________________________, nor any of the respective employees, officers, agents or assigns of ________________________________________, (hereinafter referred to as "Released Parties") may be held liable or responsible in any way for any injury, death, or other damages to me or my family, heirs, or assigns that may occur as a result of my participation in this snorkeling activity or as a result of the negligence of any party, including the Released Parties, whether passive or active.

________ In consideration of being allowed to participate in this activity I hereby personally assume all risks in connection with said trip, for any harm, injury, or damage that may befall me while I am a snorkeling participant including all risks connected therewith, whether foreseen or unforeseen.

________ I further agree to save, defend, indemnify, and hold harmless said Released Parties from any claim or lawsuit by me, anyone purporting to act on my behalf, my family, estate, heirs or assigns, arising directly or indirectly out of my participation and snorkeling activities including claims arising during this activity even if such claims may be groundless, false or fraudulent.

________ I also understand that snorkeling activities are physically strenuous and that I will be exerting myself during this snorkeling trip and that if I am injured as a result of heart attack, panic, hyperventilation, drowning, etc. that I expressly assume the risk of said injuries and that I will not hold the above listed individuals or companies responsible for the same, and I agree to defend, indemnify, and hold harmless said Released Parties for any such injuries incurred by me.

________ I understand that I may be required to furnish some of my own equipment and that I am responsible for its operating condition and maintenance..

________ I understand that I may be supplied with certain items of snorkeling equipment and that I am responsible for reviewing its proper function, fit, and operating condition prior to using it.

________ 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.


IT IS THE INTENTION OF ____________________________________ BY THIS INSTRUMENT TO EXEMPT AND RELEASE MY INSTRUCTORS DIVEMASTER/GUIDE, _________________________ THE BUSINESS, _________________________), AND ALL OTHER RELATED ENTITIES AND RELEASED PARTIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWEVER CAUSED, OR ARISING OUT OF, DIRECTLY OR INDIRECTLY, INCLUDING, BUT NOT LIMITED TO, THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND EXPRESS ASSUMPTION OF RISK BY READING IT BEFORE SIGNING IT ON BEHALF OF MYSELF AND MY HEIRS.





Phone: (207) 729-4201 Fax: (207) 729-4453

For Unguided & Unsupervised Boat Dives For Certified Divers Please read carefully, fill in all blanks and initial each paragraph before signing at bottom.

I, ______________________________, hereby affirm that I have been advised and thoroughly informed of the inherent hazards of scuba diving

activities and participation in a guided tour as a diver. ________ Further, I understand that diving with compressed air, oxygen enriched air (Nitrox), and trimix supplied by standard open circuit scuba

or with semi-closed circuit or closed circuit rebreathers involves certain inherent risks including decompression sickness, embolism, oxygen toxicity, inert gas narcosis, hypoxia, hypercapnia, marine life injuries or other barotrauma or hyperbaric injuries. Such injuries can occur that require treatment in a recompression chamber or medical facility. I further understand that dive activities can be at remote sites, and isolated by time and distance, from such a recompression chamber or medical facility. I still choose to proceed with such dives in spite of the absence of a recompression chamber in proximity to the dive site.

________ I understand and agree that neither the captain and crew ___________________________________, nor the vessel_______________________, nor any of the respective employees, officers, agents or assigns of ________________________________________, (hereinafter referred to as "Released Parties") may be held liable or responsible in any way for any injury, death, or other damages to me or my family, heirs, or assigns that may occur as a result of my participation in this diving activity or as a result of the negligence of any party, including the Released Parties, whether passive or active.

________ In consideration of being allowed to participate in this activity I hereby personally assume all risks in connection with said trip, for any harm, injury, or damage that may befall me while I am a diving participant including all risks connected therewith, whether foreseen or unforeseen.

________ I further agree to save, defend, indemnify, and hold harmless said Released Parties from any claim or lawsuit by me, anyone purporting to act on my behalf, my family, estate, heirs or assigns, arising directly or indirectly out of my participation and diving activities including claims arising during this activity even if such claims may be groundless, false or fraudulent.

________ I also understand that diving activities are physically strenuous and that I will be exerting myself during this diving trip and that if I am injured as a result of heart attack, panic, hyperventilation, oxygen toxicity, inert gas narcosis, drowning, etc. that I expressly assume the risk of said injuries and that I will not hold the above listed individuals or companies responsible for the same, and I agree to defend, indemnify, and hold harmless said Released Parties for any such injuries incurred by me.

________ I understand that these activities may place me deeper than I am able to safely execute a free ascent (without breathing gas) from. ________ I understand that I may be required to furnish some of my own equipment and that I am responsible for its operating condition and

maintenance. ________ I understand that I may be supplied with certain items of scuba equipment and that I am responsible for reviewing its proper function

and operating condition prior to using it. ________ 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 further state that I am already a qualified and certified scuba diver from the following training

agencies:__________________________, and that I hold training to the level of _____________________________________. I am aware of the required certification level and/or experience necessary and recommended to enroll in this diving activity and I stipulate that I meet those requirements for prior certification or equivalent experience. I have been a certified diver since ________ and have been diving for _____ years for a total of ______ dives to a maximum depth of ____ ft.


IT IS THE INTENTION OF ____________________________________ BY THIS INSTRUMENT TO EXEMPT AND RELEASE THE CAPTAIN/CREW___________________________________________, THE VESSEL ______________________________THE BUSINESS_________________________________ AND ALL OTHER RELATED ENTITIES AND RELEASED PARTIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWEVER CAUSED, OR ARISING OUT OF, DIRECTLY OR INDIRECTLY, INCLUDING, BUT NOT LIMITED TO, THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND EXPRESS ASSUMPTION OF RISK BY READING IT BEFORE SIGNING IT ON BEHALF OF MYSELF AND MY HEIRS.



Divemaster or Assistant Instructor Registration

Form

18 Elm Street, Topsham, Maine 04086 Phone: (207) 729-4201 Fax: (207) 729-4453

Method of Payment


Exp. Date:

Signature:

Certificates & cards are sent directly to the instructor or facility.

Certification Fee: Refer to current price list

Please Check One Only: DIVEMASTER ASSISTANT INSTRUCTOR

Print Name As It Is To Appear On Certification Card

Complete Mailing Address (including City, State and Zip Code)

Phone Number

E-mail Address



Facility Name:



Instructor Phone #:

Instructor Address:

Ship To Address:

City:

State:




Copyright© 2002 by Scuba Diving International (SDI) Revision 5.0, 11/29/04

Scuba Diving Instructor Registration Form


Phone: (207) 729-4201 Fax: (207) 729-4453

Note The Instructor Application must accompany this form

Method of Payment



Other Instructor Ratings: ANDI # PADI # PSA #

IANTD # YMCA # NAUI # SSI #

NASDS # Other (Specify): #


Certification Fee: * Instructor Upgrade Fee: * * Refer to current price list Specify Upgrade Rating:____________________________



Phone Number

E-mail Address



Facility Name:



Instructor Phone #:

Instructor Address:

Ship To Address:

City:

State:





Specialty Upgrade Form

For Instructors Only 18 Elm Street, Topsham, Maine 04086

Phone: (207) 729-4201 Fax: (207) 729-4453

Method of Payment




Certification Fee: * Refer to current price list

Please Check Only One Course Per Form

Advanced Buoyancy Control Altitude Boat Computer Diver Computer Nitrox Diver CPROX Administrator CPR1st Administrator Deep Diving (130 ft Max) Diver Propulsion Vehicle Drift Diver Dry Suit

Equipment Specialist Ice Marine Ecosystems Awareness Night /Limited Visibility Research Search & Recovery Shore/Beach U/W Hunter & Collector U/W Navigation U/W Photography U/W Video

Underwater Video VIP Wreck Other: (Specify)


Current Instructor Number:


Phone Number

E-mail Address

Please fill out the appropriate section on Page 2

BEFORE submitting the form to SDI Specialty Upgrade Form – For Instructors Only


Specialty Procedure #1 Participation in an Instructor Specialty Class

A SDI Instructor has completed an SDI Specialty Instructor Course.

Instructor Requirements: A. I agree to adhere to the SDI Specialty Course standard and outline provided by

SDI Headquarters. B. Documentation of 10 dives in that particular specialty course.

Course Location: _____________________________ Course Completion Date: ___/___/___

Instructor Trainer Signature: ____________________ SDI #________ Date: ___/___/__

Instructor Signature: ___________________________________________ Date: ___/___/___

Specialty Procedure # Administrative Specialty Instructor Upgrade An instructor who wishes to crossover his/her specialty instructor rating from another certification agency to SDI. OR An instructor who feels his/her experience in a particular specialty meets the requirements to teach a SDI specialty course.

Instructor Requirements: A. I agree to adhere to the SDI Specialty Course standard and outline provided by

SDI Headquarters. B. Documentation of 25 dives in that particular specialty course.

Instructor Signature: ________________________________________ Date: ___/___/___

Specialty Procedure #3 Request for a Specialty Instructor Upgrade An instructor who has a specialty rating that is not listed as one of the SDI Specialty courses, can apply for specialty course recognition.

Instructor Requirements: A. I agree to provide SDI Headquarters with the specialty course outline B. Complete Documentation of dive history plus documentation of 20 dives in that particular

specialty course.

Instructor Signature: ________________________________________ Date: ___/___/___

Dive History:

Specialty Upgrade Form – For Instructors Only Page 2 of 2


Open Water Global Referral Form


Student Information:

Name:

Address:

City: State:

Zip: Country:

Phone: Fax:

Email: Birth Date:

Age: Sex: M F

Original Instructor:

Facility: Phone:

Instructor’s Name:

Address:

City: State:

Zip: Country:

Phone: Fax:

Email: SDI Instructor #: I agree that the above named student has successfully fulfilled all of the academic and confined water requirements for SDI’s Open Water Scuba Diving course. As indicated by the signature below I believe the student is mentally and physically prepared to participate in open water training. Instructor Signature: _____________________________ Completion Date: ____/____/____ Check List for Original Instructor: ____ A Copy of the student’s Medical History must accompany this referral form. ____ A Signed and Completed SDI Scuba Diver Referral Form. ____ Remind student to take along his/her diver logbook and dive computer.

Expiration Date: Valid for 6 Months from completion date Open Water Global Referral Form Page 1 of 3




EVALUATING OPEN WATER INSTRUCTOR Dear evaluating instructor, The SDI referral program is designed to allow ANY active instructor to evaluate the Open Water skills and performance of a referring student. An active instructor refers to any instructor that is affiliated with an international recognized dive training agency. We appreciate your assistance with my student referral. Please review the list of required student skills, dives and instructor pre-requisites before the start of the open water evaluating process.

Evaluating Instructor must:

____ Be an Active Instructor with an internationally recognized training agency.

____ Review students’ Medical History Form. ____ Have referring student sign your facility’s waiver and release form. ____ Evaluate & initial all the required open water skills and dives listed on

the back on this form. ____ Sign this referral form. ____ Give the original referral form to student, and retain a copy of this

referral form for your records.

Thank you for your professional expertise and cooperation. Open Water Global Referral Form Page 2 of 3




Skill Performance Record

Evaluating Open Water Instructor Must Initial Each Skill When Completed

• Scuba System ____ Assembly & Disassembly • Pre-Dive Check ____ Self & Buddy ____ Underwater Communication • Computer Use ____ Reading & Understanding Gauges • Regulator Use ____ Clearing & Recovery • Mask Clear at Depth ____ Partial ____ Full • BCD ____ Auto & Oral Inflation • Entries (Demonstrate 2 types of entries) List type of entries:

• Buoyancy Control ____ Hovering ____ Controlled Ascents ____ Controlled Descents • Weight System Adjustment ____ Removal & Replacement • Out of Air Emergencies ____ Alternate Air Source ____ Share Air with Buddy while making a

controlled ascent ____ Swimming ascent • Rescue Techniques ____ Tired Diver Tow ____ Cramp Relief

Open Water Training

Dive 1

Dive 2

Dive 3

Dive 4

Date (mm/dd/yy)

Performance

Student Initials

Instructor Initials

PASS: I _______________________________, verify that all of the required open water dives and skills ( Print Name of Evaluating Instructor ) for SDI’s Open Water Scuba Diving Course have been successfully performed by the student. _______________________________________________________, #__________________ (Signature of Evaluating Instructor) Instructor # _________________________________________, Date: _______/________/________ Agency Month Day Year INCOMPLETE. Reason:_____________________________________________________

THE ORIGINAL FORM IS TO BE GIVEN BACK TO THE STUDENT, IN ORDER FOR THE STUDENT TO RECEIVE THE FINAL CERTIFICATION FROM THEIR INSTRUCTOR

Open Water Global Referral Form Page 3 of 3


Solo Diving Liability Release And

Assumption Of Risk Agreement 18 Elm Street, Topsham, Maine 04086

Phone: (207) 729-4201 Fax: (207) 729-4453

THIS IS A RELEASE OF YOUR RIGHTS TO SUE! READ IT CAREFULLY. FILL IN ALL BLANKS. INITIAL EACH PARAGRAPH BEFORE SIGNING.

I, _______________________, hereby affirm that I have been advised of the inherent hazards of solo scuba diving. Further, I understand that such diving involves certain inherent risks including, but not limited to, drowning, decompression sickness, embolism, oxygen toxicity, inert gas narcosis, marine life injuries and other types of barotrauma and/or hyperbaric injuries. I further understand that by diving alone, I may not have a dive buddy to assist me should any of these, or any other, diving malady or accident occur while I am solo diving. I, _____________________, understand and agree that neither my instructor(s): ________________, the facility __________________ through which I receive my instruction, nor SDI, Inc, nor any of their respective employees, officers, agents or assignees, nor the dive vessel, nor the dive operation through which I am granted the privilege of solo diving, nor my dive buddy, nor other participants in this solo diving activity (hereinafter referred to as Released Parties) may be held liable or responsible in any way for any injury, death or other damages to me or my family, heirs or assignees that may occur as a result of my participation in solo diving as a result of the negligence of any party, including the Released Parties, whether passive or active. I, _______________________, in consideration for being allowed to solo dive, hereby personally assume all risks in connection with this activity for any harm, injury, or damage that may befall me while I am solo diving, including all risks connected therewith, whether foreseen or unforeseen, even if caused by the negligence of the Released Parties. I, _______________________, further save and hold harmless the Released Parties from any claim or lawsuit by me, my family, estate, heirs or assignees arising out of my enrollment and participation in solo diving, including all claims arising before, during, and after this solo diving activity, even if caused by the negligence of the Released Parties. I, _______________________, further state that I am already a certified diver and have been truthful in stating my qualifications as a certified scuba diver, and have the following certifications from the following training agencies: ______________________ that I am aware of the required certification for solo scuba diving, and that I meet all requirements. I have been a certified scuba diver since: ______, and have been diving for: ______ years for a total of: _____ dives to a maximum depth of: _____ feet/meters (Circle either feet or meters).

Solo Diving Liability Release and Assumption of Risk Agreement Page 1 of 2


I, _______________________, understand that the terms herein are contractual and not a mere recital, and that I have signed this document of my own free act and will. 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. 1. PLEASE COPY THE FOLLOWING STATEMENT (IN ITS ENTIRETY) ON THE BLANK LINES PROVIDED BENEATH THIS PARAGRAPH. 2. PLEASE SIGN, DATE AND WITNESS THE FORM WHERE INDICATED. STATEMENT: IT IS MY INTENTION, BY SIGNING THIS INSTRUMENT, TO EXEMPT AND RELEASE THE RELEASED PARTIES 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.

COPY HERE: I have fully informed myself of the contents of this liability release and express assumption of risk agreement by reading it before I signed it on behalf of myself and my heirs. I understand this liability release and express assumption of risk agreement expresses the complete and whole agreement between me and the Released Parties as it relates to the issues set forth herein. __________________________________ _______________________________

Signature of Diver Date Witness Date

Solo Diving Liability Release and Assumption of Risk Agreement Page 2 of 2


Diving Accident / Incident Report


The information contained within all of the pages that make up this document is CONFIDENTIAL and PRIVILEGED. Said information is intended solely for the use of the individual to whom it is directed. If the recipient is a person / business other than those listed, you are hereby notified that any dissemination, copying, or other use of this communication is strictly prohibited. If you have received this document in error, please notify SDI (Scuba Diving International) immediately at (207) 729-4201 and destroy this document immediately thereafter. Thank you for your cooperation and courtesy in relation to this matter.

Please print or type clearly. It is extremely important that you fill in this form COMPLETELY!

Date of Accident: Name of Victim:

Location of Accident:

Address of Victim:

Sex: Age: Was this an Instructional or Supervised Dive?

Check all items applicable. Fatality: ___ Bodily Injury: ____ Bends: ____ Embolism: ____ Non-Injury: ____

Other (describe):

Describe the diving experience of the victim; was he or she a student? Novice diver? Experienced diver?

Describe the injuries suffered by the victim:

Please provide all details regarding weather conditions (water, visibility, wind, waves etc.):

Please provide details of any equipment failure:

Please describe any rescue or emergency procedures used and first aid given:

Please list any other emergency personnel / Agencies that attended:

Narrative Report: Describe the accident and the events leading up to it with your best overview, including the roles of the participants. Use additional pages if needed to give a complete account:

Your Name: Your SDI Number:

Your Address:

Your Telephone Number. Day: Evening: Please describe your current diving status (i.e. Active Instructor, Divemaster etc.):

Describe your personal participation in the incident (i.e. were you instructing the victim, a witness, called on to assist, etc.):

Please list the names, addresses and phone numbers of all other participants, witnesses. Use additional sheets if needed:


Academic Presentation


Topic:

Introductions: (Put your Name and Cert # SDI – xx, on the white board) – let students introduce themselves)

Time for presentation itself, Hours: Minutes:

1. Objective: How do I get the Attention of the student?

2. Value / Importance / Objective / Outline / Key-points: Organization and make sure the Information is correct

3. Re-State: Review Key Points, Restate Importance

4. Challenge:


In-Water Presentation


Phone: (207) 729-4201 Fax: (207) 729-4453

Introductions (Your Name, Your Divemaster’s Name – Dive Teams)

Time for presentation itself, Hours: Minutes: 1. Do a Surface Demonstration (to illustrate the skill(s)

2. Review Signs (for example: “OK”, “Go Down”, “Your turn to do the skill”, “Stop”, “Re-do”, “Surface”, “I Have a Problem”, “Equalize Ear Problem”)

3. Go down together == Students on their knees == Get an “OK” sign from each student == Watch Me Demo!

4. Demonstrate the Skill(s) == Remember, Slow & Exaggerated.

5. Evaluate each student performing the skill(s) == Get an OK from the student == Shake Their Hand

6. Surface With Students

7. Re-state the Skill(s) == Discuss Problems and Solutions == Praise and Critique == Challenge

8. Thank the Divemaster

# Skill Value / Importance / Objective / Outline / Key-points

1

2

3

4

5

6

7

8

9

10

11

12

13

14

Re-State: (Praise, Review Key Points (“You are now able to”), Re-state importance, Discuss possible problems, Answer questions students may have.)

Challenge: (Ask questions to ensure comprehension, Challenge the Student.)


sdi instructor manual part 5

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