Continuing Education Training Pass

Price:

Please Note: This pass is only valid for Non-Member students taking a Continuing Education Course without purchasing a membership. No card and key will be issued for this pass type.

Name of Instructor and/or Dive Shop*

Note: If you are applying for a Continuing Education Training Pass, you must list the name of your instructor and/or the dive shop through which you are taking your class.

Quarry Selection*

Please select the quarry where you will be taking your training.

Instructor Committe Member American Quarry*

Please select which Instructor Committee Member you interviewed with.

Instructor Committe Member JMR Quarry*

Please select which Instructor Committee Member you interviewed with

Instructor Committe Member Lake Norman Quarry*

Please select which Instructor Committee Member you interviewed with

New Instructor Information Packet*

Please upload a scanned and signed copy of your New Instructor Information Packet. Note: Incomplete packets will be rejected and not approved.

Drop files here or

Accepted file types: pdf, jpg, png, jpeg, Max. file size: 64 MB.

Instructor Certification "C" Card*

Please upload a scanned copy of your Instructor Certification "C" Card.

Drop files here or

Accepted file types: pdf, jpg, png, jpeg, Max. file size: 64 MB.

Student Date of Birth*

Student Phone*

Student Email*

Estimated Date of Instruction*

Specialty Course*

Type which Course to be taught and the Agency

To Be Completed By Student

In consideration of the acceptance of this application for membership in the PIEDMONT DIVING AND RESCUE ASSOCIATION, INC. I hereby for myself, heirs, executors or administrators and personal representatives and assigns, waive any and all claims and rights for damages which I now have or may hereafter in the future have against PIEDMONT DIVING AND RESCUE ASSOCIATION, INC. including all of its officers, agents, members, instructors, and affiliated clubs, for any and all injuries on any property owned by the PIEDMONT DIVING AND RESCUE ASSOCIATION, INC. and I hereby release and discharge the PIEDMONT DIVING AND RESCUE ASSOCIATION, INC., along with its officers, directors, agents, members, instructors, and affiliated clubs of and from any and all liabilities whatsoever to me, my heirs, executors or administrators, my personal representative or assigns on account of any and all liability arising out of such claims or injury. I am currently engaged in taking instructions from a qualified instructor of any nationally certification agency and I will dive only in his presence under his supervision. I agree to conditions of this release and are required to abide by the By-Laws, Rules & Regulations and Code of Ethics of the PIEDMONT DIVING AND RESCUE ASSOCIATION, INC., and all the rules as set forth in the Statement of Understanding and Waiver as are the certified members.) The undersigned has read the foregoing application and rules for membership and understands same. Further, the undersigned agrees to abide by and follow said rules and regulations as stated above, and understands that a violation of these rules and/or the code of ethics may result in the revocation of my student pass and other privileges.

In witness where of I hereto set my hand and seal this day of (Today's Date)*

Applicant Signature*

Signature of Parent/Guardian if under 18/Signature Family Member*

Signature Family Member*

Piedmont Diving and Rescue Association Statement of Understanding and Waiver

As a condition of my acceptance for Continuing Education Training Pass in the Piedmont Diving and Rescue Association, Inc., and/or my use of Piedmont Diving and Rescue Association, Inc. property. I subscribe, accept and acknowledge the following statement of understanding:

INHERENT HAZARDS: There are hazards in skin and scuba diving, as in all activities on or near the water, some of those hazards include, but are not limited to, drowning and air embolism and/or death. I hereby affirm that I am aware of and understand the inherent hazards of skin and scuba diving. I am adequately prepared to dive in the rock quarries owned or leased by the Piedmont Diving and Rescue Association, Inc. I am aware that I must abide by safe diving practices. At no time will I dive under the influence of alcohol or drugs or with questionable equipment or conduct any dive without (1) a buoyancy control device, (2) a submersible pressure gauge, (3) an alternate air source as a permanent and functioning part of my scuba equipment and (4) a certified buddy or dive partner. I will always have a means to monitor depth and time underwater and will make all my dives no decompression dives and will limit my maximum depth to my level of training and experience. I understand scuba diving is dangerous and can result in serious injury or death. My personal safety is my responsibility, not others’ responsibility. I will exercise reasonable care in scuba diving, the selection of my equipment, the use of that equipment and the maintenance of that equipment. I confirm that I have been properly trained and certified to the level indicated on my certification card and same is presently current. I understand and agree that the Piedmont Diving and Rescue Association, its’ officers, agents, members, or affiliated clubs shall not be held liable in any way for any occurrence in connection with my future scuba or skin diving, which may result in injury, death, or other damages to me, my family, heirs, executors, administrators and/or assigns, as evidence by my signature affixed hereto, and in consideration of which I am being allowed membership in the Piedmont Diving and Rescue Association, Inc., and/or the use of Piedmont Diving and Rescue Association, Inc., property as the guest of a member. I hereby assume all risks connected therewith, whether foreseen or unforeseen, and I agree to save, indemnify and hold harmless said above parties from any claim by me, my family, heirs, executors, administrators and/or assigns, arising out of my participation in scuba diving or skin diving. I warrant that I am of lawful age and legally competent to sign this statement of understanding, or that my parent or legal guardian understands and agrees to all terms contained herein, as evidence by my parent’s or guardian’s signature; that I understand the terms herein are contractual and not a mere recital; and that I have signed this document as my own free act and upon my own volition. It is my intention as a member or as a guest of a member of the Piedmont Diving and Rescue Association, Inc., by this instrument, to exempt and release the above listed corporation, its’ officers, agents, members, and affiliated clubs from any and all liability whatsoever for personal injury, property damage and/or wrongful death, arising from my membership in the Piedmont Diving and Rescue Association, Inc. and/or use of PDRA’s facilities. I have fully read and understand the contents of this statement of understanding and acknowledge and same

RULES AND REGULATIONS As a member or guest of the Piedmont Diving and Rescue Association, Inc., and notwithstanding anything to the contrary, in consideration of promises made, it is agreed that the undersigned shall conform to the constitution and By-Laws of the Piedmont Diving and Rescue Association, Inc., as well as the following rules and regulations: *Keep the gate LOCKED / Take all action possible to remove trespassers / Do not lend your key to non-members. *All divers MUST be accompanied by a diving buddy equipped with substantially the same type of equipment. *Spear guns shall not be taken into or used in PDRA waters (unless officially sanctioned). *There is to be no display or discharge of FIREARMS, FIREWORKS OR DYNAMITE on the property. *Do not jump or dive from quarry walls. * VEST Rule, Swimmers & Divers must wear an operable BCD, PFD/safety device or wet suit capable of providing floatation. *Do not remove items or parts of items put in quarries for your diving diversity. *Do not remove gravel or equipment from quarry belonging to a property owner. * ABSOLUTELY NO FISHING ON PDRA PROPERTY. PADDLE FISH ARE FEDERALLY PROTECTED. *No hunting allowed at any time. *No boats with gasoline motors permitted. Electric motors with weed guards permitted only when there are no other persons in the water. *PDRA members & guests shall take their litter, trash& garbage with them when leaving PDRA property. *Children shall be kept under strict supervision at all times for their safety and safety of others. *ABSOLUTELY NO PETS ON PDRA PROPERTY. * I understand that the PDRA strives to foster a family-friendly atmosphere, and will not tolerate rudeness, hostility or aggressive behavior of any kind.

In witness where of I hereto set my hand and seal this day of (Today's Date)*

Applicant Signature*

Signature of Parent/Guardian if under 18/Signature Family Member*

Signature Family Member*

Total

Date