WINDSOR SKIN & SCUBA CLUB

Membership Application

(Following is a Statement of Understanding)

One signed and witnessed application form must be completed by each diver in a family.

Personal Information

Name
Address
City
Province		Postal Code

Please check the boxes below for information that you do not wish to have published to other members.

	Home Phone Number
	Work Phone Number
	Cell Phone Number
	Other Phone Number
	Email Address

Type of Membership Requested

Individual $30

Family $45

Associate $15

Qualification Information

Certification Agency (PADI, YMCA, etc.)
Highest Level of Certification (OpenWater, Advanced, etc.)
C-Card Number
As of this date, how many dives do you have?

Release of Liability

In consideration of my acceptance for membership in the WINDSOR SKIN AND SCUBA, I do hereby for myself, my family, my invited friends, and my heirs, executors, administrators and assigns, release and forever discharge the WINDSOR SKIN AND SCUBA, its members and executors, successors and assigns from any and all actions, causes of actions, claims and demands for damages, loss or injury, howsoever arising which heretofore may have been or may hereafter be sustained by me or them in consequence of my or their participation in any activity of the WINDSOR SKIN AND SCUBA or my or their use of any of its equipment or facilities.

Dated at this day of 20

Signature

Witness

Statement of Understanding

WSSC is a dive club that encourages safe diving practices. All of its members should acknowledge their awareness of safe diving practices that will be used during official club-sanctioned dives by signing this statement when joining or rejoining the club.

Safe Diving Practices - Statement of Understanding

I, (Print Name), understand that as a diver I should:

Maintain good mental and physical fitness for diving. Avoid being under the influence of alcohol or drugs when diving. Keep proficient in diving skills, striving to increase them through continuing education and reviewing them in controlled conditions after a period of diving inactivity.
Be familiar with my dive sites. If not, obtain a diving orientation from a knowledgeable source. If diving conditions are worse than those in which I am experienced, postpone diving or select an alternate site with better conditions. Engage only in diving activities consistent with my training and experience.
Use complete, well-maintained, reliable equipment with which I am familiar; and inspect it for correct fit and function prior to each dive. Deny use of my equipment to uncertified divers. Always have a buoyancy control device and submersible pressure gauge when scuba diving. Recognize the desirability of an alternate air source, redundant gas supply and a low-pressure buoyancy control inflation system.
Listen carefully to dive briefings and respect the advice of those supervising my diving activities.
Adhere to the buddy system throughout every dive. Plan dives including communications, procedures for reuniting in case of separation, and emergency procedures with my buddy.
Be proficient in dive-table usage. Allow an appropriate margin of safety and conservatism. Have a means to monitor depth and time under water. Limit maximum depth to my level of training and experience.
Maintain proper buoyancy. Adjust weighting at the surface for neutral buoyancy with no air in my buoyancy control device. Maintain neutral buoyancy while under water. Be buoyant for surface swimming and resting. Have weights clear for easy removal, and establish buoyancy when in distress while diving. Ascend at a rate of not more than 60 feet/18 metres per minute.
Breathe properly for diving. Never breath hold or skip breathe when breathing compressed air, and avoid excessive hyperventilation when breath-hold diving. Avoid overexertion while in and under water and dive within my limitations. Avoid sharing air as a means of extending bottom time.
Use a boat, float, or other surface support station whenever feasible.
Know and obey local laws and regulations.

I have read the above statements and have had any questions answered to my satisfaction by an Instructor or Divemaster. I understand the importance and purposes of these established practices. I recognize they are for my own safety and well being, and that failure to adhere to them can potentially pose an increased risk to my personal safety.

Club Member Signature & Date	Witness Signature & Date
Signature of Parent or Guardian if Under 18 & Date

I state that that the information given on this application form for the previous year has remained unchanged or has been updated with the membership coordinator to suit my conditions for this year.

Member Signature		Date
Member Signature		Date
Member Signature		Date
Member Signature		Date
Member Signature		Date
Member Signature		Date

The portion below this line will be secured in an envelope available only to dive masters participating in official club dives. This information can be returned to the applicant upon request for any required amendments. Use the portion below, or the backside if necessary to provide more medical information that you think may be useful in an emergency.

Medical Information

Name
DAN Member Number		Medic Alert Number
Family Physician
Medical History

Allergies

Medications

Emergency Contact
Phone Number for Emergency Contact