KADENA MARINA PERSONAL TANK FORM
Last Name: ______________________ First Name :_______________________ MI:________________DoD ID Number : _____________________ Unit : ______________ Work Phone :________________
Address : ___________________________________________________________________________
Email: ___________________________________________ Personal Phone:_____________________
Certification Agency :___________________ Diver # :_______________________ Level :____________
Clubmember : Y __ N __ Valid Thru : ______ *Clubmembers get TWO free Air Fill per Day per Diver *HOLD HARMLESS AND IDEMINITY AGREEMENT : Initial Block and sign at the Bottom______ Customer agrees to hold the government harmless and to indemnify for any patron misuse thatresults in a claim against the government.
I , ________________________________, HAVE CAREFULLY READ AND UNDERSTAND THE ABOVEAGREEMENT. BY SIGNING THIS AGREEMENT I EXEMPT AND RELEASE KADENA MARINA , AND ALLRELATED ENTITIES AS DEFINED ABOVE , FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER, FOR
PROPERTY DAMAGE, OR WRONGFUL DEATH AS A RESULT OF USING THE EQUIPMENT , HOWEVER
CAUSED , INCLUDING BUT NOT LIMITED TO PRODUCT LIABILITY OR THE NEGLIGENCE OF THE RELEASEDPARTIES, WHETHER PASSIVE OR ACTIVE.

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Vis: _____________ Hydro: ___________ Drop Off Date :_________________Staff Initials : ________
Picked Up Date:________________ Staff Initials:________ Customer Initials:_______
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Vis: _____________ Hydro: ___________ Drop Off Date :_________________Staff Initials : ________
Picked Up Date:________________ Staff Initials:________ Customer Initials:___________
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Vis: _____________ Hydro: ___________ Drop Off Date :_________________Staff Initials : ________
Picked Up Date:________________ Staff Initials:________ Customer Initials:___________
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Vis: _____________ Hydro: ___________ Drop Off Date :_________________Staff Initials : ________
Picked Up Date:________________ Staff Initials:________ Customer Initials:___________
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Vis: _____________ Hydro: ___________ Drop Off Date :_________________Staff Initials : ________
Picked Up Date:________________ Staff Initials:________ Customer Initials:___________
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Vis: _____________ Hydro: ___________ Drop Off Date :_________________Staff Initials : ________
Picked Up Date:________________ Staff Initials:________ Customer Initials:___________
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Vis: _____________ Hydro: ___________ Drop Off Date :_________________Staff Initials : ________
Picked Up Date:________________ Staff Initials:________ Customer Initials:___________
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Vis: _____________ Hydro: ___________ Drop Off Date :_________________Staff Initials : ________
Picked Up Date:________________ Staff Initials:________ Customer Initials:___________
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Vis: _____________ Hydro: ___________ Drop Off Date :_________________Staff Initials : ________
Picked Up Date:________________ Staff Initials:________ Customer Initials:___________
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Vis: _____________ Hydro: ___________ Drop Off Date :_________________Staff Initials : ________
Picked Up Date:________________ Staff Initials:________ Customer Initials:___________
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Vis: _____________ Hydro: ___________ Drop Off Date :_________________Staff Initials : ________
Picked Up Date:________________ Staff Initials:________ Customer Initials:___________
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Vis: _____________ Hydro: ___________ Drop Off Date :_________________Staff Initials : ________
Picked Up Date:________________ Staff Initials:________ Customer Initials:___________
Serial #: ____________________________________________________________ Qty : ___________
Vis: _____________ Hydro: ___________ Drop Off Date :_________________Staff Initials : ________
Picked Up Date:________________ Staff Initials:________ Customer Initials:___________