On-Line Membership Application Form

General Information

Date of Application M/D/YYYY: 
Date of Birth M/D/YYYY; 
Work Phone: (will not be added to club contact "mailing" list)
Cell Phone: (will not be added to club contact "mailing" list. May save you a trip if the weather turns bad)
E-Mail Address: 
If referred by a current NDA Member, Please add name here;

Medical Information and Emergency Contacts

The following information will be carried in the club's Dan O2 kit on club dives.

Emergency Contact 1  Name   Phone
Emergency Contact 2 (different location) Name Phone
Health Card # (OHIP) Dan Member#
Blood Type Date of Last Diving Medical 
Other Emergency Medical Coverage
Known Allergies or Medical Conditions

Certifications and Experience

Agency 1 Highest Level Date Certified C-Card #
Agency 2  Highest Level Date Certified C-Card #
Agency 3 Highest Level Date Certified C-Card #
Years Diving Approx # Dives Deepest Depth Longest Dive

Statement of Understanding

Please make the appropriate selection in each box for each paragraph and realize that submitting the form is the equivalent of signing your signature.

1- I hereby confirm that I have read, understand and agree to abide by the Niagara Divers' Association Rules and Regulations and Policies and Procedures when participating in any Club dive.

2- I also understand that scuba diving is a hazardous activity in which serious injuries and even fatalities occur.  By participating in a Club dive, I acknowledge that I am voluntarily assuming the risk with full knowledge of the dangers inherent in this type of activity..

3- I agree to engage only in the type of diving for which I am certified by a recognized training agency.

4- I am also aware that some of the sites selected for Club dives are located in remote areas where emergency medical treatment facilities, including hyperbaric chambers, are not easily accessible in terms of distance and/or time.  Such facilities may be critical in the treatment of a dive-related injury.

5- I acknowledge that the Dive Coordinator appointed by the Niagara Divers' Association is not performing the duties of a Divemaster, regardless of whether or not he or she is certified to do so.  I understand that the Dive Coordinator may restrict my diving activity at his or her sole discretion to ensure the safety and enjoyment of all divers participating in the Club dive.  I agree to abide by the decisions of the Dive Coordinator on all Club dives in which I participate.

6- I hereby acknowledge that I voluntarily assume all risks related to my participation in scuba diving activities organized by the Niagara Divers' Association.  I and my executors hereby agree to waive any liability on the part of and to hold forever harmless the Niagara Divers' Association, its Executive, Dive Coordinators and members for any and all injuries and/or damages arising from any act or omission.

When the Online Application form is submitted you will be automatically taken to a  confirmation page with a link to the PayPal payment page.

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