Before You Dive

Customer Registration & Diving Forms

Below is the complete list of standard dive forms every guest must complete before diving with us. Click any form to jump straight to it, fill it out, and submit once all required sections are done.

1

Customer Registration

Demographic information & emergency contact details

Demographic Information

Block letters please

Emergency Contact Details

2

Certification Details

Your diving experience & qualifications

3

Medical Declaration

Diver Medical Participant Questionnaire

DAN, WRSTC, RSTC, RSTC Europe, UHMS, CMAS certifying body logos

Diver Medical | Participant Questionnaire

Recreational scuba diving and freediving requires good physical and mental health. There are some medical conditions which can be hazardous while diving. Those who have, or are predisposed to, any of these conditions, should be evaluated by a physician. This questionnaire provides a basis to determine if you should seek out that evaluation. If you have any concerns about your diving fitness not represented on this form, consult with your physician before diving. If you are feeling ill, avoid diving.

Directions

If you answer NO to all 10 questions below, a medical evaluation is not required. Please read and agree to the participant statement below by signing and dating it.

*If you answer YES to questions 3, 5 or 10 below OR to any of the questions on page 2, you must sign and date the statement below AND take this form to your physician for a medical evaluation before diving.

Note to women: If you are pregnant, or attempting to become pregnant, do not dive.

1.

I have had problems with my lungs, breathing, heart and/or blood affecting my normal physical or mental performance. (Go to box A)

2.

I am over 45 years of age. (Go to box B)

3.

I struggle to perform moderate exercise (for example, walk 1.6 kilometer/one mile in 14 minutes or swim 200 meters/yards without resting), or I have been unable to participate in a normal physical activity due to fitness or health reasons within the past 12 months.

*
4.

I have had problems with my eyes, ears, or nasal passages/sinuses or teeth. (Go to box C)

5.

I have had surgery within the last 12 months, or I have ongoing problems related to past surgery.

*
6.

I have lost consciousness, had migraine headaches, seizures, stroke, significant head injury, or suffer from persistent neurologic injury or disease. I have a condition where sudden neurological compromise/impairment is possible. (Go to box D)

7.

I am currently undergoing treatment (or have required treatment within the last five years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning or developmental disability. (Go to box E)

8.

I have had back problems, hernia, ulcers, or diabetes. (Go to box F)

9.

I have had stomach or intestine problems, including recent diarrhea. (Go to box G)

10.

I am currently taking one or more prescription medications. (Note: this need not include birth control, menopausal hormone replacement, and antimalarial medication unless it is mefloquine [Lariam]).

*

Participant Questionnaire Continued

*Physician's medical evaluation required if any box item below is answered Yes.

BOX A – I HAVE/HAVE HAD:

Chest surgery, heart surgery, heart valve surgery, an implantable medical device (eg, stent, pacemaker, neurostimulator), pneumothorax, and/or chronic lung disease.

Asthma, wheezing, severe allergies, hay fever or congested airways within the last 12 months that limits my physical activity/exercise.

A problem or illness involving my heart such as: angina, chest pain on exertion, heart failure, immersion pulmonary edema, heart attack or stroke, or am taking medication for any heart condition.

Recurrent bronchitis and currently coughing within the past 12 months, or have been diagnosed with emphysema.

Symptoms affecting my lungs, breathing, heart and/or blood in the last 30 days that impair my physical or mental performance.

BOX B – I AM OVER 45 YEARS OF AGE AND:

I currently smoke or inhale nicotine by other means.

I have a high cholesterol level.

I have high blood pressure.

I have had a close blood relative die suddenly or of cardiac disease or stroke before the age of 50, or have a family history of heart disease before age 50 (including abnormal heart rhythms, coronary artery disease or cardiomyopathy).

BOX C – I HAVE/HAVE HAD:

Sinus surgery within the last 6 months.

Ear disease or ear surgery, hearing loss, or problems with balance.

Recurrent sinusitis within the past 12 months.

Eye surgery within the past 3 months.

Still healing / recovering from recent dental / oral procedure.

BOX D – I HAVE/HAVE HAD:

Head injury with loss of consciousness within the past 5 years.

Persistent neurologic injury or disease, to include episodic and/or unpredictable loss, reduction, or change in neurological, cognitive, or motor function or performance.

Recurring migraine headaches within the past 12 months, or take medications to prevent them.

Blackouts or fainting (full/partial loss of consciousness) within the last 5 years.

Epilepsy, seizures, or convulsions, or take medications to prevent them.

BOX E – I HAVE/HAVE HAD:

Behavioral health, mental, or psychological problems requiring medical/psychiatric treatment.

Major depression, suicidal ideation, panic attacks, uncontrolled bipolar disorder requiring medication/psychiatric treatment.

Been diagnosed with a mental health condition or a learning/developmental disorder that requires ongoing care or special accommodation.

An addiction to drugs or alcohol requiring treatment within the last 5 years.

BOX F – I HAVE/HAVE HAD:

Recurrent back problems in the last 6 months that limit my everyday activity.

Back or spinal surgery within the last 12 months.

Diabetes, either drug or diet controlled, or gestational diabetes within the last 12 months.

An uncorrected hernia that limits my physical abilities.

Active or untreated ulcers, problem wounds, or ulcer surgery within the last 6 months.

BOX G – I HAVE HAD:

Ostomy surgery and do not have medical clearance to swim or engage in physical activity.

Dehydration requiring medical intervention within the last 7 days.

Active or untreated stomach or intestinal ulcers or ulcer surgery within the last 6 months.

Frequent heartburn, regurgitation, or gastroesophageal reflux disease (GERD).

Active or uncontrolled ulcerative colitis or Crohn's disease.

Bariatric surgery within the last 12 months.

Participant Signature

Participant Statement: I have answered all questions honestly, and understand that I accept responsibility for any consequences resulting from any questions I may have answered inaccurately or for my failure to disclose any existing or past health conditions.

Participant Signature (or, if a minor, parent/guardian signature)
Participant Name (Print)
Instructor Name (Print)
Facility Name (Print)
4

Statement of Risks and Liability

Please read carefully before signing

Training & Education

Please read carefully before signing.

  1. 1.It is important that you read the contents of this statement before signing it.
  2. 2.Scuba diving training involves certain inherent risks including the risk of serious injury or death.
  3. 3.You must be in good physical and mental health to participate in training activities.
  4. 4.You must follow all instructions given by your instructor at all times during training.
  5. 5.Warning: failure to follow instructions or to disclose relevant medical conditions may result in serious injury or death.
  6. 6.You must advise truthfully and fully inform the instructor(s) of any medical condition, medication, or concern that may affect your ability to dive safely.
  7. 7.The instructor reserves the right to refuse or terminate training if they consider it unsafe for you to continue.
  8. 8.You are responsible for your own actions during training and accept the consequences of failing to follow instructions.
  9. 9.The training provider accepts no liability for injury or loss arising from your failure to follow instructions or to disclose relevant information.

Rental of scuba equipment & supply of breathing gases

  1. 1.You confirm that any equipment rented is suitable for your level of training and experience.
  2. 2.You must inspect all rented equipment before use and report any defects immediately.
  3. 3.You must use rented equipment only for its intended purpose and in accordance with instructions.
  4. 4.Breathing gases supplied are suitable for the purpose intended, provided they are used correctly.
  5. 5.Warning: improper use of scuba equipment or breathing gases can cause serious injury or death.
  6. 6.You must advise truthfully and fully inform the supplier of any medical condition that may be affected by the use of breathing gases.
  7. 7.The supplier accepts no liability for injury or loss arising from misuse, unauthorised modification, or failure to follow instructions.
  8. 8.You are responsible for the care of rented equipment and will be liable for loss or damage caused by your negligence.
  9. 9.You must return all rented equipment in the condition in which it was supplied, fair wear and tear excepted.
  10. 10.The supplier reserves the right to charge for any cleaning, repair, or replacement necessitated by your negligence.

Guided and Organised Diving

  1. 1.Guided dives are organised for certified divers of the appropriate level of experience.
  2. 2.You must present proof of certification and recent diving experience before participating.
  3. 3.You must follow the dive plan and the instructions of the dive leader at all times.
  4. 4.You are responsible for ensuring your own equipment is functioning correctly before each dive.
  5. 5.Warning: diving involves risks including decompression sickness, barotrauma, drowning, and encounters with marine life.
  6. 6.You must advise truthfully and fully inform the dive leader of any medical condition or concern that may affect your ability to dive safely.
  7. 7.You must dive within your training, experience, and physical limitations at all times.
  8. 8.The organiser accepts no liability for injury or loss arising from your failure to follow the dive plan or instructions, or from your own negligence.
  9. 9.You acknowledge that the organiser is not responsible for providing insurance cover for you; you are responsible for arranging your own dive and travel insurance.
  10. 10.You participate in guided and organised dives entirely at your own risk.

I acknowledge receipt of this Statement and have read all of the terms before signing this Statement.

Participant Name (Block Letters)
Participant Signature
Name of Parent/Guardian (Block Letters)
Signature of Parent/Guardian

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