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Queensland Government
Workplace Health and Safety

DEED OF ASSUMPTION OF RISK

In consideration of and as a condition of Sunshine Coast Diving Centre Pty Ltd ACN 010 180 220 – trading as “Scuba World” (hereafter “the business”) agreeing to allow me to participate or enroll in any one or more of the following:

(a) Scuba diving

(b) Snorkeling

(c) Instruction in scuba diving or snorkeling

(d) use of any material plant or equipment; and

(e) any activity incidental to the above activities conducted, supplied or serviced by the instructor, the business and / SSI (hereafter referred to as “the Aquatic Activities”)

Hereby covenant acknowledge and agree that so far as permitted by the Competition and Consumer Act 2010 (Cth) and the Fair Trading Act 1989 (QLD):

1. I unconditionally waive and relinquish all claims for liability and release and discharge the instructor, the business and/or SSI, from all liabilities, claims and causes of action that may arise for: (1) Personal Injury (2) Property Damage (3) Economic Loss or (4) Wrongful Death. Wherever and however such may occur whether the same shall arise by (5) Negligence (6) Breach of Contract (7) Breach of any statute, code of practice or standard (8) Delay or cancellation. Or otherwise (hereafter “the liabilities”) as a result of my participation in the Aquatic Activities.

2. I agree to indemnify and hold harmless the instructor, the business and/or SSI from the Liabilities in respect of any action brought against them as a result of my participation in the Aquatic Activities.

3. I affirm that I am not subject to any further medical conditions other than those noted in attached medical declaration for resort diving form.

4. I acknowledge that:

a. My participation in the Aquatic Activities is a potentially hazardous activity which may result in serious injury, property damage, economic loss or death and I am prepared to assume such risks.

b. I have been fully advised of the potential dangers and hazards associated with my participation in the Aquatic Activities; and

c. I have read and understood this Deed and I intend it to have legal effect to exempt and relieve the instructor, the business and/or SSI from the Liabilities and have signed it voluntarily and without any inducement by SSI and /or the Business.

d. You reserve your rights to deny your service at any time I demonstrate unsafe practices to yourself or to my fellow divers during any dive.

Interpretation

A Reference to a party to this Deed included the Party’s successors, assigns, agents, servants and employees.

Executed as a Deed on April 25, 2024.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

MEDICAL DECLARATION FOR SCUBA DIVING

Have you suffered, or do you now suffer from, any of the following

Asthma or wheezing*
No
Yes
Brain, spinal cord or nervous disorder*
No
Yes
Chest surgery*
No
Yes
Chronic bronchitis or persistent chest complaint*
No
Yes
Chronic sinus conditions*
No
Yes
Collapsed lung (pneumothorax)*
No
Yes
Diabetes mellitus (sugar diabetes)*
No
Yes
Ear surgery*
No
Yes
Epilepsy*
No
Yes
Fainting, seizures or blackouts*
No
Yes
Heart disease of any kind*
No
Yes
Recurrent ear problems when flying*
No
Yes
Tuberculosis or other long-term lung disease*
No
Yes

Are you currently suffering from

Breathlessness*
No
Yes
Chronic ear discharge or infection*
No
Yes
High blood pressure*
No
Yes
Other illness or operation within the last month*
No
Yes
Perforated eardrum*
No
Yes
Are you currently taking any medication or drug (excluding oral contraceptives)?*
No
Yes
Have you ingested any alcohol within the 8 hours prior to diving?*
No
Yes
Are you pregnant?*
No
Yes
Do you understand that concealment of any condition incompatible with safe diving might put your life or health at risk?*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

MEDICAL DECLARATION FOR SCUBA DIVING

Have you suffered, or do you now suffer from, any of the following

Asthma or wheezing*
No
Yes
Brain, spinal cord or nervous disorder*
No
Yes
Chest surgery*
No
Yes
Chronic bronchitis or persistent chest complaint*
No
Yes
Chronic sinus conditions*
No
Yes
Collapsed lung (pneumothorax)*
No
Yes
Diabetes mellitus (sugar diabetes)*
No
Yes
Ear surgery*
No
Yes
Epilepsy*
No
Yes
Fainting, seizures or blackouts*
No
Yes
Heart disease of any kind*
No
Yes
Recurrent ear problems when flying*
No
Yes
Tuberculosis or other long-term lung disease*
No
Yes

Are you currently suffering from

Breathlessness*
No
Yes
Chronic ear discharge or infection*
No
Yes
High blood pressure*
No
Yes
Other illness or operation within the last month*
No
Yes
Perforated eardrum*
No
Yes
Are you currently taking any medication or drug (excluding oral contraceptives)?*
No
Yes
Have you ingested any alcohol within the 8 hours prior to diving?*
No
Yes
Are you pregnant?*
No
Yes
Do you understand that concealment of any condition incompatible with safe diving might put your life or health at risk?*
No
Yes
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

MEDICAL DECLARATION FOR SCUBA DIVING

Have you suffered, or do you now suffer from, any of the following

Asthma or wheezing*
No
Yes
Brain, spinal cord or nervous disorder*
No
Yes
Chest surgery*
No
Yes
Chronic bronchitis or persistent chest complaint*
No
Yes
Chronic sinus conditions*
No
Yes
Collapsed lung (pneumothorax)*
No
Yes
Diabetes mellitus (sugar diabetes)*
No
Yes
Ear surgery*
No
Yes
Epilepsy*
No
Yes
Fainting, seizures or blackouts*
No
Yes
Heart disease of any kind*
No
Yes
Recurrent ear problems when flying*
No
Yes
Tuberculosis or other long-term lung disease*
No
Yes

Are you currently suffering from

Breathlessness*
No
Yes
Chronic ear discharge or infection*
No
Yes
High blood pressure*
No
Yes
Other illness or operation within the last month*
No
Yes
Perforated eardrum*
No
Yes
Are you currently taking any medication or drug (excluding oral contraceptives)?*
No
Yes
Have you ingested any alcohol within the 8 hours prior to diving?*
No
Yes
Are you pregnant?*
No
Yes
Do you understand that concealment of any condition incompatible with safe diving might put your life or health at risk?*
No
Yes
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

MEDICAL DECLARATION FOR SCUBA DIVING

Have you suffered, or do you now suffer from, any of the following

Asthma or wheezing*
No
Yes
Brain, spinal cord or nervous disorder*
No
Yes
Chest surgery*
No
Yes
Chronic bronchitis or persistent chest complaint*
No
Yes
Chronic sinus conditions*
No
Yes
Collapsed lung (pneumothorax)*
No
Yes
Diabetes mellitus (sugar diabetes)*
No
Yes
Ear surgery*
No
Yes
Epilepsy*
No
Yes
Fainting, seizures or blackouts*
No
Yes
Heart disease of any kind*
No
Yes
Recurrent ear problems when flying*
No
Yes
Tuberculosis or other long-term lung disease*
No
Yes

Are you currently suffering from

Breathlessness*
No
Yes
Chronic ear discharge or infection*
No
Yes
High blood pressure*
No
Yes
Other illness or operation within the last month*
No
Yes
Perforated eardrum*
No
Yes
Are you currently taking any medication or drug (excluding oral contraceptives)?*
No
Yes
Have you ingested any alcohol within the 8 hours prior to diving?*
No
Yes
Are you pregnant?*
No
Yes
Do you understand that concealment of any condition incompatible with safe diving might put your life or health at risk?*
No
Yes
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

MEDICAL DECLARATION FOR SCUBA DIVING

Have you suffered, or do you now suffer from, any of the following

Asthma or wheezing*
No
Yes
Brain, spinal cord or nervous disorder*
No
Yes
Chest surgery*
No
Yes
Chronic bronchitis or persistent chest complaint*
No
Yes
Chronic sinus conditions*
No
Yes
Collapsed lung (pneumothorax)*
No
Yes
Diabetes mellitus (sugar diabetes)*
No
Yes
Ear surgery*
No
Yes
Epilepsy*
No
Yes
Fainting, seizures or blackouts*
No
Yes
Heart disease of any kind*
No
Yes
Recurrent ear problems when flying*
No
Yes
Tuberculosis or other long-term lung disease*
No
Yes

Are you currently suffering from

Breathlessness*
No
Yes
Chronic ear discharge or infection*
No
Yes
High blood pressure*
No
Yes
Other illness or operation within the last month*
No
Yes
Perforated eardrum*
No
Yes
Are you currently taking any medication or drug (excluding oral contraceptives)?*
No
Yes
Have you ingested any alcohol within the 8 hours prior to diving?*
No
Yes
Are you pregnant?*
No
Yes
Do you understand that concealment of any condition incompatible with safe diving might put your life or health at risk?*
No
Yes
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

MEDICAL DECLARATION FOR SCUBA DIVING

Have you suffered, or do you now suffer from, any of the following

Asthma or wheezing*
No
Yes
Brain, spinal cord or nervous disorder*
No
Yes
Chest surgery*
No
Yes
Chronic bronchitis or persistent chest complaint*
No
Yes
Chronic sinus conditions*
No
Yes
Collapsed lung (pneumothorax)*
No
Yes
Diabetes mellitus (sugar diabetes)*
No
Yes
Ear surgery*
No
Yes
Epilepsy*
No
Yes
Fainting, seizures or blackouts*
No
Yes
Heart disease of any kind*
No
Yes
Recurrent ear problems when flying*
No
Yes
Tuberculosis or other long-term lung disease*
No
Yes

Are you currently suffering from

Breathlessness*
No
Yes
Chronic ear discharge or infection*
No
Yes
High blood pressure*
No
Yes
Other illness or operation within the last month*
No
Yes
Perforated eardrum*
No
Yes
Are you currently taking any medication or drug (excluding oral contraceptives)?*
No
Yes
Have you ingested any alcohol within the 8 hours prior to diving?*
No
Yes
Are you pregnant?*
No
Yes
Do you understand that concealment of any condition incompatible with safe diving might put your life or health at risk?*
No
Yes
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

MEDICAL DECLARATION FOR SCUBA DIVING

Have you suffered, or do you now suffer from, any of the following

Asthma or wheezing*
No
Yes
Brain, spinal cord or nervous disorder*
No
Yes
Chest surgery*
No
Yes
Chronic bronchitis or persistent chest complaint*
No
Yes
Chronic sinus conditions*
No
Yes
Collapsed lung (pneumothorax)*
No
Yes
Diabetes mellitus (sugar diabetes)*
No
Yes
Ear surgery*
No
Yes
Epilepsy*
No
Yes
Fainting, seizures or blackouts*
No
Yes
Heart disease of any kind*
No
Yes
Recurrent ear problems when flying*
No
Yes
Tuberculosis or other long-term lung disease*
No
Yes

Are you currently suffering from

Breathlessness*
No
Yes
Chronic ear discharge or infection*
No
Yes
High blood pressure*
No
Yes
Other illness or operation within the last month*
No
Yes
Perforated eardrum*
No
Yes
Are you currently taking any medication or drug (excluding oral contraceptives)?*
No
Yes
Have you ingested any alcohol within the 8 hours prior to diving?*
No
Yes
Are you pregnant?*
No
Yes
Do you understand that concealment of any condition incompatible with safe diving might put your life or health at risk?*
No
Yes
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

MEDICAL DECLARATION FOR SCUBA DIVING

Have you suffered, or do you now suffer from, any of the following

Asthma or wheezing*
No
Yes
Brain, spinal cord or nervous disorder*
No
Yes
Chest surgery*
No
Yes
Chronic bronchitis or persistent chest complaint*
No
Yes
Chronic sinus conditions*
No
Yes
Collapsed lung (pneumothorax)*
No
Yes
Diabetes mellitus (sugar diabetes)*
No
Yes
Ear surgery*
No
Yes
Epilepsy*
No
Yes
Fainting, seizures or blackouts*
No
Yes
Heart disease of any kind*
No
Yes
Recurrent ear problems when flying*
No
Yes
Tuberculosis or other long-term lung disease*
No
Yes

Are you currently suffering from

Breathlessness*
No
Yes
Chronic ear discharge or infection*
No
Yes
High blood pressure*
No
Yes
Other illness or operation within the last month*
No
Yes
Perforated eardrum*
No
Yes
Are you currently taking any medication or drug (excluding oral contraceptives)?*
No
Yes
Have you ingested any alcohol within the 8 hours prior to diving?*
No
Yes
Are you pregnant?*
No
Yes
Do you understand that concealment of any condition incompatible with safe diving might put your life or health at risk?*
No
Yes
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

MEDICAL DECLARATION FOR SCUBA DIVING

Have you suffered, or do you now suffer from, any of the following

Asthma or wheezing*
No
Yes
Brain, spinal cord or nervous disorder*
No
Yes
Chest surgery*
No
Yes
Chronic bronchitis or persistent chest complaint*
No
Yes
Chronic sinus conditions*
No
Yes
Collapsed lung (pneumothorax)*
No
Yes
Diabetes mellitus (sugar diabetes)*
No
Yes
Ear surgery*
No
Yes
Epilepsy*
No
Yes
Fainting, seizures or blackouts*
No
Yes
Heart disease of any kind*
No
Yes
Recurrent ear problems when flying*
No
Yes
Tuberculosis or other long-term lung disease*
No
Yes

Are you currently suffering from

Breathlessness*
No
Yes
Chronic ear discharge or infection*
No
Yes
High blood pressure*
No
Yes
Other illness or operation within the last month*
No
Yes
Perforated eardrum*
No
Yes
Are you currently taking any medication or drug (excluding oral contraceptives)?*
No
Yes
Have you ingested any alcohol within the 8 hours prior to diving?*
No
Yes
Are you pregnant?*
No
Yes
Do you understand that concealment of any condition incompatible with safe diving might put your life or health at risk?*
No
Yes
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

MEDICAL DECLARATION FOR SCUBA DIVING

Have you suffered, or do you now suffer from, any of the following

Asthma or wheezing*
No
Yes
Brain, spinal cord or nervous disorder*
No
Yes
Chest surgery*
No
Yes
Chronic bronchitis or persistent chest complaint*
No
Yes
Chronic sinus conditions*
No
Yes
Collapsed lung (pneumothorax)*
No
Yes
Diabetes mellitus (sugar diabetes)*
No
Yes
Ear surgery*
No
Yes
Epilepsy*
No
Yes
Fainting, seizures or blackouts*
No
Yes
Heart disease of any kind*
No
Yes
Recurrent ear problems when flying*
No
Yes
Tuberculosis or other long-term lung disease*
No
Yes

Are you currently suffering from

Breathlessness*
No
Yes
Chronic ear discharge or infection*
No
Yes
High blood pressure*
No
Yes
Other illness or operation within the last month*
No
Yes
Perforated eardrum*
No
Yes
Are you currently taking any medication or drug (excluding oral contraceptives)?*
No
Yes
Have you ingested any alcohol within the 8 hours prior to diving?*
No
Yes
Are you pregnant?*
No
Yes
Do you understand that concealment of any condition incompatible with safe diving might put your life or health at risk?*
No
Yes
Parent or Guardian's Email Address

Email*
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
As a parent or guardian, I am signing this document on behalf of a minor child. Additionally, I have read and considered the above information contained herein, understand the risks of injury while snorkeling or scuba diving, and have had the opportunity to personally discuss the diving activities or instructional program with the instructor prior to the commencement of the minor child’s snorkeling or scuba diving activities. I am aware of the legal consequences of signing this agreement, and do thereby agree to be specifically bound to all terms and conditions of this agreement on behalf of the minor child.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

MEDICAL DECLARATION FOR SCUBA DIVING

Have you suffered, or do you now suffer from, any of the following

Asthma or wheezing*
No
Yes
Brain, spinal cord or nervous disorder*
No
Yes
Chest surgery*
No
Yes
Chronic bronchitis or persistent chest complaint*
No
Yes
Chronic sinus conditions*
No
Yes
Collapsed lung (pneumothorax)*
No
Yes
Diabetes mellitus (sugar diabetes)*
No
Yes
Ear surgery*
No
Yes
Epilepsy*
No
Yes
Fainting, seizures or blackouts*
No
Yes
Heart disease of any kind*
No
Yes
Recurrent ear problems when flying*
No
Yes
Tuberculosis or other long-term lung disease*
No
Yes

Are you currently suffering from

Breathlessness*
No
Yes
Chronic ear discharge or infection*
No
Yes
High blood pressure*
No
Yes
Other illness or operation within the last month*
No
Yes
Perforated eardrum*
No
Yes
Are you currently taking any medication or drug (excluding oral contraceptives)?*
No
Yes
Have you ingested any alcohol within the 8 hours prior to diving?*
No
Yes
Are you pregnant?*
No
Yes
Do you understand that concealment of any condition incompatible with safe diving might put your life or health at risk?*
No
Yes
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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