Loading...

Medical Questionaire for all participants doing the Sunreef Discover Scuba Diving Experience.

Scuba diving is an exciting and demanding activity. To scuba dive safely, you must not be extremely overweight or out of condition. Diving can be strenuous under certain conditions. Your respiratory and circulatory systems must be in good health. All body spaces must be normal and healthy. A person with heart trouble, a current cold or congestion, epilepsy, asthma, a severe medical problem, or is who under the influence of alcohol or drugs, should not dive. If taking medication, consult your doctor before taking part in this program.

The purpose of this Medical Declaration is to find out if you should be examined by a physician before participating in recreational diving. A positive response to a question does not necessarily disqualify you from diving. A positive response means there is a preexisting condition that may affect your safety while diving and you must seek the advice of a physician.

Please answer the following questions on your past and present with a YES or NO. If you are not sure, answer YES. If any of these items apply to you, we must request that you consult with a physician prior to participating  in scuba  diving. Your instructor will supply you with a PADI Medical Statement and Guidelines for Recreational Scuba Diver's Physical Examination to take to a physician

Please read the following points carefully.

I understand and state that I am physically and mentally capable to participate successfully in open sea condition diving. I further acknowledge that Sunreef Diving will give no refunds for seasickness, inability to equalize or for any other reason that prevents an individual from participating fully.

I Agree

I have no medical condition that would affect my ability to safely dive and I am not taking any medication that has not been approved by my physician for diving. I am not currently under the effect of alcohol or drugs.

I Agree

I will not fly within 24hrs from surfacing after my last dive.

I Agree

Sunreef may cancel or change trip destinations at any time due to weather or any other unforeseen circumstances.

I Agree

Sunreef may change the time of my trip due to weather or any other unforseen circumstances.

I Agree

If you wish to change your booking in any way, it must be done at least 72hrs prior to the planned start time of your trip. Changes made with in the 72hrs will incur a charge of $129.

I Agree

I will follow the direction of Sunreef staff at all times to ensure a safe and fluid operation. I will listen to all briefings and seek advice if I don't understand any part of the brief.

I Agree

I take the responsibility for checking the safe and correct operation of my dive equipment prior to diving whether the equipment be provided by myself or Sunreef Hire Gear.

I Agree

By acknowledging this, I agree to release Sunreef, its employees/contractors or associated agents from being sued for personal injury, wrongful death or damage to personal equipment. I am fully aware of the contents of this form and have clearly read and understood all the above points. This document is valid for 12 months from date of submission.

Please select who will be participating...
AdultMinor
Continue
First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Have you suffered from, or do you now suffer from, any of the following:
Asthma or wheezing?*
No
Yes
Fainting, seizures or blackouts?*
No
Yes
Chronic Bronchitis or persistent chest complaints?*
No
Yes
Chronic Sinus Conditions?*
No
Yes
Chest Surgery?*
No
Yes
Recurrent ear problems when flying?*
No
Yes
Epilepsy?*
No
Yes
Diabetes Mellitus (sugar diabetes?)*
No
Yes
Tuberculosis or other long term lung disease?*
No
Yes
Brain, Spinal cord or nervous disorder?*
No
Yes
Collapsed Lung (Pneumothorax?)*
No
Yes
Ear Surgery?*
No
Yes
Are you currently suffering from?
Breathlessness?*
No
Yes
Chronic Ear Discharge or infection?*
No
Yes
High Blood Pressure?*
No
Yes
Perforated eardrum?*
No
Yes
Other illness or operation within the last month?*
No
Yes
Are you currently taking any medicine or drug (excluding oral contraceptive?)*
No
Yes
Have you ingested any alcohol within the last 8 hours prior to diving?*
No
Yes
Are you pregnant?*
No
Yes
Do you understand that any concealment of any condition incompatible with safe diving might put your health or life at risk?*
No
Yes
Do you understand that you should not go to altitude (fly within 12 hours of completing a single dive or 18 hours when doing multiple dives (where possible wait 24 hours)?*
No
Yes
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

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


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!