Trip Agreement | Gypsy Divers

Thank you for signing up for a trip with us! This agreement is sent to our trip leaders to ensure we’re all on the same page. It also gives our trip leaders a chance to get to know you and your diving history before the trip so that they can plan accordingly.

Destination Information:
Destination Name:*
Trip Date*
Trip Leader(s):
Personal Information:
Your name as it appears on your passport:*
Passport EXPIRATION DATE (Must be 6 months after the trip):*
MM slash DD slash YYYY
Your Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Are you a US Citizen?*
- Yes
- No
Your Email*
Your Phone*
Who should we call in an emergency?*
Relationship to you?
Emergency Contact Phone*
Do you have an active Medical Statement Form signed within 1 year of the trip?
Most dive shops, liveaboards, dive destinations, etc, require a medical form. We’re just making sure you have time to get it signed off, if you need to! You can find a copy of this form under our “Forms” page.
- Yes, it’s already on my SSI profile and I’ll have a copy
- Yes, I have a copy
- No and I understand it will need to be completed BEFORE traveling
Do you have dive insurance active for this trip?*
- Divers Alert Network
- DiveAssure
- I choose not to use dive insurance
Do you have a Travel Protection Plan for this trip?*
- Yes
- No, but plan to.
- No, and understand that all monies paid for this trip are non-refundable without exception.
Are you planning on taking specialties during this trip?
- Yes, I already have this scheduled with my trip leader
- No, but I’m interested, I’ll reach out to my trip leader
- No, I don’t want to.
Information About Your Diving Experience
Are you a certified Open Water diver or will you be certified before this trip?*
- Yes, I’m already certified
- I’m currently in class and doing certification dives before the trip
- I’m doing certification dives on the trip
- No, I’m a non-diver
Have you dove in the last year?*
- Yes
- No and I plan on diving before the trip
- No and I DON’T have any plans to dive before the trip
How do you rate your diving abilities?
- I’m a new diver – not much experience
- I’m intermediate – reasonably experienced
- I’m an experienced diver – well over 100 dives
Number of Dives
For each question, you can give an estimate
How many dives do you have logged?
How many ocean dives have you logged?
How many dives deeper than 100 feet have you logged?
How many night dives have you logged?
How many drift dives have you logged?
How many wreck dives have you logged?
Our Trip Policies and Waivers
Please carefully read and then check the box under each paragraph below. And please FULLY UNDERSTAND that, by doing so, you are acknowledging that you understand the information presented and you agree to follow that policy.
Trip Communication*
Your trip leaders will send out a few emails leading up to the trip. These emails contain important information regarding your trip and often ask for information from you. The trip leaders often need this information to further plan the trip, for example, arranging airport transportation.
I agree to read all emails regarding the trip and will respond promptly
Intermediate Payments*
Most of our trips have a trip payment plan established from the beginning. Gypsy Divers will charge the last card used for trip payments on the scheduled dates for the scheduled amounts.
I agree that my card on file will be charged on the schedule intermediate payment dates
Deposit and Payment*
This completed application and a deposit are necessary at the time of booking. Full payment is generally due 45 to 90 days prior to departure. Bookings made within 60 days of departure are to be PAID IN FULL and may be assessed additional fees if administrative expenses are incurred. Certain more extensive trips may require a larger deposit ($500 – $1,000) and require following a multiple payment schedule.
I agree to this deposit and payment policy
Trip Modification*
Any agent or employee of Gypsy Divers reserves the right to modify the trip program and/or change the trip price for any reason. In the event of a price change, the applicant shall have the right to cancel with a full refund.
I agree to this trip modification policy.
Waiver of Liability*
The applicant, or the undersigned parents/guardians of an applicant under the age of maturity, releases and absolves The Elite Gypsy Corporation, DBA Gypsy Divers, William Harloff III, and any and all agents and employees of Gypsy Divers from any and all liability for property loss or damage, and/or from any and all damages resulting from death or personal injuries, including loss of services arising out of, or in conjunction with applicant’s chosen travel program, whether resulting from negligence of anyone in charge of or participating in said program or from ownership, maintenance, use, operation or control of any automobile, ship, airplane, bicycle, boat, vehicle, inn, hotel, common carrier, or otherwise.
I understand and agree to this waiver of liability
Limits of Responsibility*
It is understood that the agents and employees of Gypsy Divers are independent of, and have no business association, partnership, joint venture, ownership or otherwise, with any resort, hotel, carrier, boat operator, or other person or firm furnishing any service or facility in connection with the subject travel program.
It is expressly understood and agreed that any agent or employee of Gypsy Divers assumes no responsibility or liability for service, transportation, or equipment made available by any resort, hotel, or other person or entity, either as to its availability or as to its safety, quality, or condition, nor for the acts of any employee or agent of such establishment, firm, or entity.
It is also understood and agreed that any agent or employee of Gypsy Divers does not, by acceptance of this applicant, assume any responsibility or liability for the safety of any participating individual, particularly when such individual is engaged in underwater activities, whether alone or in groups, under the supervision of tour escort, or otherwise.
It is expressly understood that Gypsy Divers, its agents, and employees, cannot verify either the ability or suitability to scuba dive of each trip participant and therefore cannot guarantee that the participant will be allowed to dive by the dive operator. If the diving proficiency of the participant is not acceptable, a refund for the diving portion of the trip is totally at the discretion of the dive operator. Gypsy Divers will return to the trip participant any refund offered by the dive operator, less any reasonable charges or expenses incurred in securing that refund.
It is expressly understood that the tour escort of the trip is acting only in the capacity of a tour escort. Although the escort may or may not be a certified scuba instructor, and will give freely of his/her diving knowledge and experience, the escort is not acting in the capacity of instructor unless specifically noted by a separate agreement.
It is expressly understood that, due to the possible remoteness of the destination, access to adequate first responder treatment, immediate medical care, and appropriate hyperbaric care facilities (recompression chambers) may be extremely limited if not totally unavailable without considerable transport. For this reason, we VERY STRONGLY advise all trip participants to be insured through the Divers Alert Network or DiveAssure.
I understand and agree to this limits of responsibility policy.
Substitutions, Modifications, Changes*
It is further understood and agreed that the remoteness of the area, new local government regulation, customs, prevailing weather conditions, or any other factors may cause substitution of facilities and/or equipment, minor inconvenience, or modification of the travel itinerary. All agents and employees of Gypsy Divers reserve the right to modify and/or cancel diving arrangements due to unfavorable weather conditions or any other reason that may affect the safety of the group, and to substitute facilities and equipment if necessary. No refunds can be made for arrangements canceled due to adverse weather, mechanical failure, or for substitution of facilities and/or equipment, or for minor inconvenience. Unused portions of trips are non-refundable.
I agree to this policy on substitutions, modifications, and changes
Our VERY UGLY Cancellation Policy*
When a space on a tour is sold, it is removed from our tour inventory and no further attempts are made to sell that space. Some destinations require a certain group size to guarantee special services and rates. For this reason, all trip deposits are completely non-refundable. Once the final payment is made, it too becomes 100% non-refundable, whether or not the trip eventually sells out. If you cancel at any point, your money is forfeit, period. NO exceptions. We strongly advise our travelers to obtain trip interruption/cancellation protection programs in the event of a forced or unforeseen trip cancellation.
I agree to this VERY UGLY CANCELLATION POLICY.
I affirm by my electronic signature below that I consent to the policies and waivers presented above.*

Destination Information:

Personal Information:

Information About Your Diving Experience

Number of Dives

Our Trip Policies and Waivers