Please complete the following information to register in the adult class at Cygnus Diving Club. Official registration is complete only when a completed form and payment has been received, and receipt of payment has been issued. If you have any questions about registration please contact info@cygnusdiving.ca.

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Programs, schedule, and coaching are all subject to change. Minimum class sizes must be met to run a class.

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Diver Information

Name (First Last)*

Birthdate*

Street Address*

City*

Province*

Postcode*

Email*

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Emergency Contact

Name*

Phone number*

Cell Phone*

Relationship to Registrant*

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Medical Information

Health Card Number

Family Physician Name

Physician Phone Number

Medical Conditions*

Medications*

Allergies (if any)*

Photo Consent and Media Release Form

I hereby grant consent to Cygnus Diving Club and the Nova Scotia Amateur Diving Association (NSADA) to reproduce and/or use photos taken or obtained of the registered diver for use in the promotion of Cygnus Diving Club and NSADA

I understand and agree that any and all photographs, recordings, films or reproductions may be used to promote the athletes, Cygnus Diving Club and NSADA.

I herby release Cygnus Diving Club and its officers, directors, agents and employees from any and all liability arising from the rights granted hereby and from the use of my name and likeness as herein authorized.

I understand that reproduction and usage of my image, name, likeness and/or written comments through any media come without compensation and are solely for the purpose of promoting the sport, Cygnus Diving Club, and NSADA.

I understand that the image or likeness of me may appear in print materials (such as brochures, displays, posters, or advertising), or online (website and social media).

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I DO Consent

I DO NOT Consent

I am aware that accidents and injury are an inherent risk of diving and can happen without any fault on the part of the instructors/coaches, Cygnus Diving Club or Centennial Pool. By agreeing to participate in this activity, I, the registrant accept the risk of accident and injury and agree that the activity as described in the program information is suitable for the registrant.

I, the registrant, agree to hold harmless Cygnus Diving Club and Centennial Pool, and all its instructors and coaches from any and all claims for injury, loss or damage arising from my participation in diving related activities

Diver Name*

Cygnus Diving Club

Adult Class Registration January 2025

Diver Information

Emergency Contact

Medical Information

Photo Consent and Media Release Form

A springboard and platform diving club in Halifax, NS.