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STATEMENT OF RISKS AND LIABILITY | BOAT-BASED TRIPS


Please read carefully and fill in all blanks before signing.

This is a statement in which you are informed of the risks of swimming and skin diving in open water. The statement also sets out the circumstances in which you participate in the diving programme at your own risk.

Your signature on this statement is required as proof that you have received and read this statement. It is important that you read the contents of this statement before signing it. If you do not understand anything contained in this statement, then please discuss it with your guide If you are a minor, a parent or guardian must also sign this form.

WARNING

On the boat there is a chance of tripping, slipping and falling on the deck, while in movement. We ask you to take responsibility for storing your kit under your seat and holding onto the rails to steady yourself when moving around. We ask that you take sea sickness pills if you feel you may need them to avoid being unwell on the journey. It is not uncommon for people to feel nauseous during a day trip. Bring plenty of water to stay hydrated and food to eat to avoid exhaustion.

Skin diving has inherent risks, which may result in serious injury or death. Diving in open water involves risks such as cold water shock, drowning, sea sickness. You will be entering the water with wild animals. You must be passive in the water and respect the animals space. You will be accompanied by an experienced guide, but must follow the rules as set out in the boat briefing on in water conduct.

Open water trips may be conducted at a site that is remote, either by time or distance or both, from a treatment centre. We have first aid equipment on board so can administer primary care.

Open water swimming and skin diving is a physically strenuous activity and you will be exerting yourself during this trip. You must truthfully and fully inform the guide and Celtic Deep of your medical history.

See full risk assessment: https://docs.google.com/document/d/e/2PACX-1vTm9hez1BfHuwiZDBhwg6Q9KPXGvuEi9pVjsXsBXfRoeS62hR4xjQmz1hJjiPVoOHMY6As2q26NNTlP/pub

EXCLUSION OF LIABILITY

I understand and agree that the Celtic Deep dive professionals conducting this programme do not accept any responsibility for any death, injury or other loss suffered or caused by me or resulting from my own conduct or any matter or condition under my control that amounts to my own contributory negligence.

In the absence of any negligence or other breach of duty by the Celtic Deep dive professionals conducting this programme, my participation in this day trip and open water swimming experience is entirely at my own risk.

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

It is the participants responsibility to ensure they have the correct equipment for in water activity and to stay warm afterwards, as laid out in the booking information document. If the participant does not have the correct in water wear they will not be able to enter the water for their own safety and wellbeing.

* It is your responsibility to make sure your gear is in good working order *


Dated: May 19, 2024



First Participant's Name

First Name*

Last Name*

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

MEDICAL STATEMENT 

**IMPORTANT - PLEASE READ

** Freediving and snorkelling is a strenuous activity carried out in the underwater environment, which may, under certain conditions, increase your risk of injury. This risk may be significantly increased if you have certain physical conditions. These same physical conditions would not necessarily be a safety factor in other strenuous activities or sports. Celtic Deep therefore uses the following questionnaire to make you aware of these conditions. 

Failure to address these conditions prior to engaging in open water swimming and breath hold diving activity may endanger your health, your safety and the safety of any person you may dive with in the future. 

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in in water activities. A positive response to a question does not necessarily disqualify you from participation. A positive response means that there is a pre-existing condition that may affect your safety while in water and you MUST seek the advice of a physician prior to engaging in these activities. The physician needs to sign at the bottom of the form to say that he/she finds no medical conditions incompatible with snorkelling or freediving. if any 'YES' box is ticked. Please answer the following questions on your past or present medical history by ticking the box marked YES or NO. If you are not sure, answer YES.

Neurological Conditions (If YES doctor sign-off required): Especially any history of seizure disorder, stroke, brain surgery, repeated black outs or fainting fits, severe migraine headaches, or aneurysm of the brain's blood vessels*
No
Yes
Cardiovascular Conditions (If YES doctor sign-off required): Especially heart attack, heart surgery, irregular heart beat, uncontrolled elevated blood pressure*
No
Yes
Pulmonary Conditions (If YES doctor sign-off required): Especially a history of spontaneous collapsed lung, collapsed lung due to injury, cysts or air pockets of the lungs, severe damage to lung tissue, emphysema, or any lung problem which interferes with your ability to breathe*
No
Yes
Ear Conditions: Permanent holes of the eardrums, history of ruptured eardrum, permanent tubes in eardrums, severely impaired hearing or hearing loss in one or both ears, or major ear surgery*
No
Yes
Sinus Conditions: Tumour, polyps, or cyst of the sinus cavities or nasal passages, major sinus surgery, or persistent sinus infection*
No
Yes
Asthma: History of asthma or asthma attacks. Any history of wheezing caused by exercise, anxiety, cold, fatigue, etc. Any condition requiring medication and/or use of an inhaler for control of wheezing*
No
Yes
Diabetes Mellitus: Especially Type I Diabetes (Insulin dependent) or Type II Diabetes, which requires insulin or oral medication for control. Any form of Diabetes that is unstable, "brittle" or produces episodes of hypoglycaemia (low blood sugar reactions), hyperglycaemia (extremely high blood sugar with ketosis) or if there is related kidney disease, eye disease, heart disease or blood vessel disease.*
No
Yes
Pregnancy (If YES we're afraid you can not participate): If you are presently pregnant or planning to be pregnant*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician*
No
Yes
Freediving/ Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*

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

MEDICAL STATEMENT 

**IMPORTANT - PLEASE READ

** Freediving and snorkelling is a strenuous activity carried out in the underwater environment, which may, under certain conditions, increase your risk of injury. This risk may be significantly increased if you have certain physical conditions. These same physical conditions would not necessarily be a safety factor in other strenuous activities or sports. Celtic Deep therefore uses the following questionnaire to make you aware of these conditions. 

Failure to address these conditions prior to engaging in open water swimming and breath hold diving activity may endanger your health, your safety and the safety of any person you may dive with in the future. 

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in in water activities. A positive response to a question does not necessarily disqualify you from participation. A positive response means that there is a pre-existing condition that may affect your safety while in water and you MUST seek the advice of a physician prior to engaging in these activities. The physician needs to sign at the bottom of the form to say that he/she finds no medical conditions incompatible with snorkelling or freediving. if any 'YES' box is ticked. Please answer the following questions on your past or present medical history by ticking the box marked YES or NO. If you are not sure, answer YES.

Neurological Conditions (If YES doctor sign-off required): Especially any history of seizure disorder, stroke, brain surgery, repeated black outs or fainting fits, severe migraine headaches, or aneurysm of the brain's blood vessels*
No
Yes
Cardiovascular Conditions (If YES doctor sign-off required): Especially heart attack, heart surgery, irregular heart beat, uncontrolled elevated blood pressure*
No
Yes
Pulmonary Conditions (If YES doctor sign-off required): Especially a history of spontaneous collapsed lung, collapsed lung due to injury, cysts or air pockets of the lungs, severe damage to lung tissue, emphysema, or any lung problem which interferes with your ability to breathe*
No
Yes
Ear Conditions: Permanent holes of the eardrums, history of ruptured eardrum, permanent tubes in eardrums, severely impaired hearing or hearing loss in one or both ears, or major ear surgery*
No
Yes
Sinus Conditions: Tumour, polyps, or cyst of the sinus cavities or nasal passages, major sinus surgery, or persistent sinus infection*
No
Yes
Asthma: History of asthma or asthma attacks. Any history of wheezing caused by exercise, anxiety, cold, fatigue, etc. Any condition requiring medication and/or use of an inhaler for control of wheezing*
No
Yes
Diabetes Mellitus: Especially Type I Diabetes (Insulin dependent) or Type II Diabetes, which requires insulin or oral medication for control. Any form of Diabetes that is unstable, "brittle" or produces episodes of hypoglycaemia (low blood sugar reactions), hyperglycaemia (extremely high blood sugar with ketosis) or if there is related kidney disease, eye disease, heart disease or blood vessel disease.*
No
Yes
Pregnancy (If YES we're afraid you can not participate): If you are presently pregnant or planning to be pregnant*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician*
No
Yes
Freediving/ Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air*
No
Yes
Third Participant's Name

First Name*

Last Name*

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

MEDICAL STATEMENT 

**IMPORTANT - PLEASE READ

** Freediving and snorkelling is a strenuous activity carried out in the underwater environment, which may, under certain conditions, increase your risk of injury. This risk may be significantly increased if you have certain physical conditions. These same physical conditions would not necessarily be a safety factor in other strenuous activities or sports. Celtic Deep therefore uses the following questionnaire to make you aware of these conditions. 

Failure to address these conditions prior to engaging in open water swimming and breath hold diving activity may endanger your health, your safety and the safety of any person you may dive with in the future. 

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in in water activities. A positive response to a question does not necessarily disqualify you from participation. A positive response means that there is a pre-existing condition that may affect your safety while in water and you MUST seek the advice of a physician prior to engaging in these activities. The physician needs to sign at the bottom of the form to say that he/she finds no medical conditions incompatible with snorkelling or freediving. if any 'YES' box is ticked. Please answer the following questions on your past or present medical history by ticking the box marked YES or NO. If you are not sure, answer YES.

Neurological Conditions (If YES doctor sign-off required): Especially any history of seizure disorder, stroke, brain surgery, repeated black outs or fainting fits, severe migraine headaches, or aneurysm of the brain's blood vessels*
No
Yes
Cardiovascular Conditions (If YES doctor sign-off required): Especially heart attack, heart surgery, irregular heart beat, uncontrolled elevated blood pressure*
No
Yes
Pulmonary Conditions (If YES doctor sign-off required): Especially a history of spontaneous collapsed lung, collapsed lung due to injury, cysts or air pockets of the lungs, severe damage to lung tissue, emphysema, or any lung problem which interferes with your ability to breathe*
No
Yes
Ear Conditions: Permanent holes of the eardrums, history of ruptured eardrum, permanent tubes in eardrums, severely impaired hearing or hearing loss in one or both ears, or major ear surgery*
No
Yes
Sinus Conditions: Tumour, polyps, or cyst of the sinus cavities or nasal passages, major sinus surgery, or persistent sinus infection*
No
Yes
Asthma: History of asthma or asthma attacks. Any history of wheezing caused by exercise, anxiety, cold, fatigue, etc. Any condition requiring medication and/or use of an inhaler for control of wheezing*
No
Yes
Diabetes Mellitus: Especially Type I Diabetes (Insulin dependent) or Type II Diabetes, which requires insulin or oral medication for control. Any form of Diabetes that is unstable, "brittle" or produces episodes of hypoglycaemia (low blood sugar reactions), hyperglycaemia (extremely high blood sugar with ketosis) or if there is related kidney disease, eye disease, heart disease or blood vessel disease.*
No
Yes
Pregnancy (If YES we're afraid you can not participate): If you are presently pregnant or planning to be pregnant*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician*
No
Yes
Freediving/ Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air*
No
Yes
Fourth Participant's Name

First Name*

Last Name*

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

MEDICAL STATEMENT 

**IMPORTANT - PLEASE READ

** Freediving and snorkelling is a strenuous activity carried out in the underwater environment, which may, under certain conditions, increase your risk of injury. This risk may be significantly increased if you have certain physical conditions. These same physical conditions would not necessarily be a safety factor in other strenuous activities or sports. Celtic Deep therefore uses the following questionnaire to make you aware of these conditions. 

Failure to address these conditions prior to engaging in open water swimming and breath hold diving activity may endanger your health, your safety and the safety of any person you may dive with in the future. 

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in in water activities. A positive response to a question does not necessarily disqualify you from participation. A positive response means that there is a pre-existing condition that may affect your safety while in water and you MUST seek the advice of a physician prior to engaging in these activities. The physician needs to sign at the bottom of the form to say that he/she finds no medical conditions incompatible with snorkelling or freediving. if any 'YES' box is ticked. Please answer the following questions on your past or present medical history by ticking the box marked YES or NO. If you are not sure, answer YES.

Neurological Conditions (If YES doctor sign-off required): Especially any history of seizure disorder, stroke, brain surgery, repeated black outs or fainting fits, severe migraine headaches, or aneurysm of the brain's blood vessels*
No
Yes
Cardiovascular Conditions (If YES doctor sign-off required): Especially heart attack, heart surgery, irregular heart beat, uncontrolled elevated blood pressure*
No
Yes
Pulmonary Conditions (If YES doctor sign-off required): Especially a history of spontaneous collapsed lung, collapsed lung due to injury, cysts or air pockets of the lungs, severe damage to lung tissue, emphysema, or any lung problem which interferes with your ability to breathe*
No
Yes
Ear Conditions: Permanent holes of the eardrums, history of ruptured eardrum, permanent tubes in eardrums, severely impaired hearing or hearing loss in one or both ears, or major ear surgery*
No
Yes
Sinus Conditions: Tumour, polyps, or cyst of the sinus cavities or nasal passages, major sinus surgery, or persistent sinus infection*
No
Yes
Asthma: History of asthma or asthma attacks. Any history of wheezing caused by exercise, anxiety, cold, fatigue, etc. Any condition requiring medication and/or use of an inhaler for control of wheezing*
No
Yes
Diabetes Mellitus: Especially Type I Diabetes (Insulin dependent) or Type II Diabetes, which requires insulin or oral medication for control. Any form of Diabetes that is unstable, "brittle" or produces episodes of hypoglycaemia (low blood sugar reactions), hyperglycaemia (extremely high blood sugar with ketosis) or if there is related kidney disease, eye disease, heart disease or blood vessel disease.*
No
Yes
Pregnancy (If YES we're afraid you can not participate): If you are presently pregnant or planning to be pregnant*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician*
No
Yes
Freediving/ Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air*
No
Yes
Fifth Participant's Name

First Name*

Last Name*

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

MEDICAL STATEMENT 

**IMPORTANT - PLEASE READ

** Freediving and snorkelling is a strenuous activity carried out in the underwater environment, which may, under certain conditions, increase your risk of injury. This risk may be significantly increased if you have certain physical conditions. These same physical conditions would not necessarily be a safety factor in other strenuous activities or sports. Celtic Deep therefore uses the following questionnaire to make you aware of these conditions. 

Failure to address these conditions prior to engaging in open water swimming and breath hold diving activity may endanger your health, your safety and the safety of any person you may dive with in the future. 

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in in water activities. A positive response to a question does not necessarily disqualify you from participation. A positive response means that there is a pre-existing condition that may affect your safety while in water and you MUST seek the advice of a physician prior to engaging in these activities. The physician needs to sign at the bottom of the form to say that he/she finds no medical conditions incompatible with snorkelling or freediving. if any 'YES' box is ticked. Please answer the following questions on your past or present medical history by ticking the box marked YES or NO. If you are not sure, answer YES.

Neurological Conditions (If YES doctor sign-off required): Especially any history of seizure disorder, stroke, brain surgery, repeated black outs or fainting fits, severe migraine headaches, or aneurysm of the brain's blood vessels*
No
Yes
Cardiovascular Conditions (If YES doctor sign-off required): Especially heart attack, heart surgery, irregular heart beat, uncontrolled elevated blood pressure*
No
Yes
Pulmonary Conditions (If YES doctor sign-off required): Especially a history of spontaneous collapsed lung, collapsed lung due to injury, cysts or air pockets of the lungs, severe damage to lung tissue, emphysema, or any lung problem which interferes with your ability to breathe*
No
Yes
Ear Conditions: Permanent holes of the eardrums, history of ruptured eardrum, permanent tubes in eardrums, severely impaired hearing or hearing loss in one or both ears, or major ear surgery*
No
Yes
Sinus Conditions: Tumour, polyps, or cyst of the sinus cavities or nasal passages, major sinus surgery, or persistent sinus infection*
No
Yes
Asthma: History of asthma or asthma attacks. Any history of wheezing caused by exercise, anxiety, cold, fatigue, etc. Any condition requiring medication and/or use of an inhaler for control of wheezing*
No
Yes
Diabetes Mellitus: Especially Type I Diabetes (Insulin dependent) or Type II Diabetes, which requires insulin or oral medication for control. Any form of Diabetes that is unstable, "brittle" or produces episodes of hypoglycaemia (low blood sugar reactions), hyperglycaemia (extremely high blood sugar with ketosis) or if there is related kidney disease, eye disease, heart disease or blood vessel disease.*
No
Yes
Pregnancy (If YES we're afraid you can not participate): If you are presently pregnant or planning to be pregnant*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician*
No
Yes
Freediving/ Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air*
No
Yes
Sixth Participant's Name

First Name*

Last Name*

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

MEDICAL STATEMENT 

**IMPORTANT - PLEASE READ

** Freediving and snorkelling is a strenuous activity carried out in the underwater environment, which may, under certain conditions, increase your risk of injury. This risk may be significantly increased if you have certain physical conditions. These same physical conditions would not necessarily be a safety factor in other strenuous activities or sports. Celtic Deep therefore uses the following questionnaire to make you aware of these conditions. 

Failure to address these conditions prior to engaging in open water swimming and breath hold diving activity may endanger your health, your safety and the safety of any person you may dive with in the future. 

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in in water activities. A positive response to a question does not necessarily disqualify you from participation. A positive response means that there is a pre-existing condition that may affect your safety while in water and you MUST seek the advice of a physician prior to engaging in these activities. The physician needs to sign at the bottom of the form to say that he/she finds no medical conditions incompatible with snorkelling or freediving. if any 'YES' box is ticked. Please answer the following questions on your past or present medical history by ticking the box marked YES or NO. If you are not sure, answer YES.

Neurological Conditions (If YES doctor sign-off required): Especially any history of seizure disorder, stroke, brain surgery, repeated black outs or fainting fits, severe migraine headaches, or aneurysm of the brain's blood vessels*
No
Yes
Cardiovascular Conditions (If YES doctor sign-off required): Especially heart attack, heart surgery, irregular heart beat, uncontrolled elevated blood pressure*
No
Yes
Pulmonary Conditions (If YES doctor sign-off required): Especially a history of spontaneous collapsed lung, collapsed lung due to injury, cysts or air pockets of the lungs, severe damage to lung tissue, emphysema, or any lung problem which interferes with your ability to breathe*
No
Yes
Ear Conditions: Permanent holes of the eardrums, history of ruptured eardrum, permanent tubes in eardrums, severely impaired hearing or hearing loss in one or both ears, or major ear surgery*
No
Yes
Sinus Conditions: Tumour, polyps, or cyst of the sinus cavities or nasal passages, major sinus surgery, or persistent sinus infection*
No
Yes
Asthma: History of asthma or asthma attacks. Any history of wheezing caused by exercise, anxiety, cold, fatigue, etc. Any condition requiring medication and/or use of an inhaler for control of wheezing*
No
Yes
Diabetes Mellitus: Especially Type I Diabetes (Insulin dependent) or Type II Diabetes, which requires insulin or oral medication for control. Any form of Diabetes that is unstable, "brittle" or produces episodes of hypoglycaemia (low blood sugar reactions), hyperglycaemia (extremely high blood sugar with ketosis) or if there is related kidney disease, eye disease, heart disease or blood vessel disease.*
No
Yes
Pregnancy (If YES we're afraid you can not participate): If you are presently pregnant or planning to be pregnant*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician*
No
Yes
Freediving/ Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air*
No
Yes
Seventh Participant's Name

First Name*

Last Name*

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

MEDICAL STATEMENT 

**IMPORTANT - PLEASE READ

** Freediving and snorkelling is a strenuous activity carried out in the underwater environment, which may, under certain conditions, increase your risk of injury. This risk may be significantly increased if you have certain physical conditions. These same physical conditions would not necessarily be a safety factor in other strenuous activities or sports. Celtic Deep therefore uses the following questionnaire to make you aware of these conditions. 

Failure to address these conditions prior to engaging in open water swimming and breath hold diving activity may endanger your health, your safety and the safety of any person you may dive with in the future. 

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in in water activities. A positive response to a question does not necessarily disqualify you from participation. A positive response means that there is a pre-existing condition that may affect your safety while in water and you MUST seek the advice of a physician prior to engaging in these activities. The physician needs to sign at the bottom of the form to say that he/she finds no medical conditions incompatible with snorkelling or freediving. if any 'YES' box is ticked. Please answer the following questions on your past or present medical history by ticking the box marked YES or NO. If you are not sure, answer YES.

Neurological Conditions (If YES doctor sign-off required): Especially any history of seizure disorder, stroke, brain surgery, repeated black outs or fainting fits, severe migraine headaches, or aneurysm of the brain's blood vessels*
No
Yes
Cardiovascular Conditions (If YES doctor sign-off required): Especially heart attack, heart surgery, irregular heart beat, uncontrolled elevated blood pressure*
No
Yes
Pulmonary Conditions (If YES doctor sign-off required): Especially a history of spontaneous collapsed lung, collapsed lung due to injury, cysts or air pockets of the lungs, severe damage to lung tissue, emphysema, or any lung problem which interferes with your ability to breathe*
No
Yes
Ear Conditions: Permanent holes of the eardrums, history of ruptured eardrum, permanent tubes in eardrums, severely impaired hearing or hearing loss in one or both ears, or major ear surgery*
No
Yes
Sinus Conditions: Tumour, polyps, or cyst of the sinus cavities or nasal passages, major sinus surgery, or persistent sinus infection*
No
Yes
Asthma: History of asthma or asthma attacks. Any history of wheezing caused by exercise, anxiety, cold, fatigue, etc. Any condition requiring medication and/or use of an inhaler for control of wheezing*
No
Yes
Diabetes Mellitus: Especially Type I Diabetes (Insulin dependent) or Type II Diabetes, which requires insulin or oral medication for control. Any form of Diabetes that is unstable, "brittle" or produces episodes of hypoglycaemia (low blood sugar reactions), hyperglycaemia (extremely high blood sugar with ketosis) or if there is related kidney disease, eye disease, heart disease or blood vessel disease.*
No
Yes
Pregnancy (If YES we're afraid you can not participate): If you are presently pregnant or planning to be pregnant*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician*
No
Yes
Freediving/ Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air*
No
Yes
Eighth Participant's Name

First Name*

Last Name*

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

MEDICAL STATEMENT 

**IMPORTANT - PLEASE READ

** Freediving and snorkelling is a strenuous activity carried out in the underwater environment, which may, under certain conditions, increase your risk of injury. This risk may be significantly increased if you have certain physical conditions. These same physical conditions would not necessarily be a safety factor in other strenuous activities or sports. Celtic Deep therefore uses the following questionnaire to make you aware of these conditions. 

Failure to address these conditions prior to engaging in open water swimming and breath hold diving activity may endanger your health, your safety and the safety of any person you may dive with in the future. 

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in in water activities. A positive response to a question does not necessarily disqualify you from participation. A positive response means that there is a pre-existing condition that may affect your safety while in water and you MUST seek the advice of a physician prior to engaging in these activities. The physician needs to sign at the bottom of the form to say that he/she finds no medical conditions incompatible with snorkelling or freediving. if any 'YES' box is ticked. Please answer the following questions on your past or present medical history by ticking the box marked YES or NO. If you are not sure, answer YES.

Neurological Conditions (If YES doctor sign-off required): Especially any history of seizure disorder, stroke, brain surgery, repeated black outs or fainting fits, severe migraine headaches, or aneurysm of the brain's blood vessels*
No
Yes
Cardiovascular Conditions (If YES doctor sign-off required): Especially heart attack, heart surgery, irregular heart beat, uncontrolled elevated blood pressure*
No
Yes
Pulmonary Conditions (If YES doctor sign-off required): Especially a history of spontaneous collapsed lung, collapsed lung due to injury, cysts or air pockets of the lungs, severe damage to lung tissue, emphysema, or any lung problem which interferes with your ability to breathe*
No
Yes
Ear Conditions: Permanent holes of the eardrums, history of ruptured eardrum, permanent tubes in eardrums, severely impaired hearing or hearing loss in one or both ears, or major ear surgery*
No
Yes
Sinus Conditions: Tumour, polyps, or cyst of the sinus cavities or nasal passages, major sinus surgery, or persistent sinus infection*
No
Yes
Asthma: History of asthma or asthma attacks. Any history of wheezing caused by exercise, anxiety, cold, fatigue, etc. Any condition requiring medication and/or use of an inhaler for control of wheezing*
No
Yes
Diabetes Mellitus: Especially Type I Diabetes (Insulin dependent) or Type II Diabetes, which requires insulin or oral medication for control. Any form of Diabetes that is unstable, "brittle" or produces episodes of hypoglycaemia (low blood sugar reactions), hyperglycaemia (extremely high blood sugar with ketosis) or if there is related kidney disease, eye disease, heart disease or blood vessel disease.*
No
Yes
Pregnancy (If YES we're afraid you can not participate): If you are presently pregnant or planning to be pregnant*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician*
No
Yes
Freediving/ Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air*
No
Yes
Ninth Participant's Name

First Name*

Last Name*

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

MEDICAL STATEMENT 

**IMPORTANT - PLEASE READ

** Freediving and snorkelling is a strenuous activity carried out in the underwater environment, which may, under certain conditions, increase your risk of injury. This risk may be significantly increased if you have certain physical conditions. These same physical conditions would not necessarily be a safety factor in other strenuous activities or sports. Celtic Deep therefore uses the following questionnaire to make you aware of these conditions. 

Failure to address these conditions prior to engaging in open water swimming and breath hold diving activity may endanger your health, your safety and the safety of any person you may dive with in the future. 

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in in water activities. A positive response to a question does not necessarily disqualify you from participation. A positive response means that there is a pre-existing condition that may affect your safety while in water and you MUST seek the advice of a physician prior to engaging in these activities. The physician needs to sign at the bottom of the form to say that he/she finds no medical conditions incompatible with snorkelling or freediving. if any 'YES' box is ticked. Please answer the following questions on your past or present medical history by ticking the box marked YES or NO. If you are not sure, answer YES.

Neurological Conditions (If YES doctor sign-off required): Especially any history of seizure disorder, stroke, brain surgery, repeated black outs or fainting fits, severe migraine headaches, or aneurysm of the brain's blood vessels*
No
Yes
Cardiovascular Conditions (If YES doctor sign-off required): Especially heart attack, heart surgery, irregular heart beat, uncontrolled elevated blood pressure*
No
Yes
Pulmonary Conditions (If YES doctor sign-off required): Especially a history of spontaneous collapsed lung, collapsed lung due to injury, cysts or air pockets of the lungs, severe damage to lung tissue, emphysema, or any lung problem which interferes with your ability to breathe*
No
Yes
Ear Conditions: Permanent holes of the eardrums, history of ruptured eardrum, permanent tubes in eardrums, severely impaired hearing or hearing loss in one or both ears, or major ear surgery*
No
Yes
Sinus Conditions: Tumour, polyps, or cyst of the sinus cavities or nasal passages, major sinus surgery, or persistent sinus infection*
No
Yes
Asthma: History of asthma or asthma attacks. Any history of wheezing caused by exercise, anxiety, cold, fatigue, etc. Any condition requiring medication and/or use of an inhaler for control of wheezing*
No
Yes
Diabetes Mellitus: Especially Type I Diabetes (Insulin dependent) or Type II Diabetes, which requires insulin or oral medication for control. Any form of Diabetes that is unstable, "brittle" or produces episodes of hypoglycaemia (low blood sugar reactions), hyperglycaemia (extremely high blood sugar with ketosis) or if there is related kidney disease, eye disease, heart disease or blood vessel disease.*
No
Yes
Pregnancy (If YES we're afraid you can not participate): If you are presently pregnant or planning to be pregnant*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician*
No
Yes
Freediving/ Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air*
No
Yes
Tenth Participant's Name

First Name*

Last Name*

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

MEDICAL STATEMENT 

**IMPORTANT - PLEASE READ

** Freediving and snorkelling is a strenuous activity carried out in the underwater environment, which may, under certain conditions, increase your risk of injury. This risk may be significantly increased if you have certain physical conditions. These same physical conditions would not necessarily be a safety factor in other strenuous activities or sports. Celtic Deep therefore uses the following questionnaire to make you aware of these conditions. 

Failure to address these conditions prior to engaging in open water swimming and breath hold diving activity may endanger your health, your safety and the safety of any person you may dive with in the future. 

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in in water activities. A positive response to a question does not necessarily disqualify you from participation. A positive response means that there is a pre-existing condition that may affect your safety while in water and you MUST seek the advice of a physician prior to engaging in these activities. The physician needs to sign at the bottom of the form to say that he/she finds no medical conditions incompatible with snorkelling or freediving. if any 'YES' box is ticked. Please answer the following questions on your past or present medical history by ticking the box marked YES or NO. If you are not sure, answer YES.

Neurological Conditions (If YES doctor sign-off required): Especially any history of seizure disorder, stroke, brain surgery, repeated black outs or fainting fits, severe migraine headaches, or aneurysm of the brain's blood vessels*
No
Yes
Cardiovascular Conditions (If YES doctor sign-off required): Especially heart attack, heart surgery, irregular heart beat, uncontrolled elevated blood pressure*
No
Yes
Pulmonary Conditions (If YES doctor sign-off required): Especially a history of spontaneous collapsed lung, collapsed lung due to injury, cysts or air pockets of the lungs, severe damage to lung tissue, emphysema, or any lung problem which interferes with your ability to breathe*
No
Yes
Ear Conditions: Permanent holes of the eardrums, history of ruptured eardrum, permanent tubes in eardrums, severely impaired hearing or hearing loss in one or both ears, or major ear surgery*
No
Yes
Sinus Conditions: Tumour, polyps, or cyst of the sinus cavities or nasal passages, major sinus surgery, or persistent sinus infection*
No
Yes
Asthma: History of asthma or asthma attacks. Any history of wheezing caused by exercise, anxiety, cold, fatigue, etc. Any condition requiring medication and/or use of an inhaler for control of wheezing*
No
Yes
Diabetes Mellitus: Especially Type I Diabetes (Insulin dependent) or Type II Diabetes, which requires insulin or oral medication for control. Any form of Diabetes that is unstable, "brittle" or produces episodes of hypoglycaemia (low blood sugar reactions), hyperglycaemia (extremely high blood sugar with ketosis) or if there is related kidney disease, eye disease, heart disease or blood vessel disease.*
No
Yes
Pregnancy (If YES we're afraid you can not participate): If you are presently pregnant or planning to be pregnant*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician*
No
Yes
Freediving/ Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air*
No
Yes
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
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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.


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*

Last Name*

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

MEDICAL STATEMENT 

**IMPORTANT - PLEASE READ

** Freediving and snorkelling is a strenuous activity carried out in the underwater environment, which may, under certain conditions, increase your risk of injury. This risk may be significantly increased if you have certain physical conditions. These same physical conditions would not necessarily be a safety factor in other strenuous activities or sports. Celtic Deep therefore uses the following questionnaire to make you aware of these conditions. 

Failure to address these conditions prior to engaging in open water swimming and breath hold diving activity may endanger your health, your safety and the safety of any person you may dive with in the future. 

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in in water activities. A positive response to a question does not necessarily disqualify you from participation. A positive response means that there is a pre-existing condition that may affect your safety while in water and you MUST seek the advice of a physician prior to engaging in these activities. The physician needs to sign at the bottom of the form to say that he/she finds no medical conditions incompatible with snorkelling or freediving. if any 'YES' box is ticked. Please answer the following questions on your past or present medical history by ticking the box marked YES or NO. If you are not sure, answer YES.

Neurological Conditions (If YES doctor sign-off required): Especially any history of seizure disorder, stroke, brain surgery, repeated black outs or fainting fits, severe migraine headaches, or aneurysm of the brain's blood vessels*
No
Yes
Cardiovascular Conditions (If YES doctor sign-off required): Especially heart attack, heart surgery, irregular heart beat, uncontrolled elevated blood pressure*
No
Yes
Pulmonary Conditions (If YES doctor sign-off required): Especially a history of spontaneous collapsed lung, collapsed lung due to injury, cysts or air pockets of the lungs, severe damage to lung tissue, emphysema, or any lung problem which interferes with your ability to breathe*
No
Yes
Ear Conditions: Permanent holes of the eardrums, history of ruptured eardrum, permanent tubes in eardrums, severely impaired hearing or hearing loss in one or both ears, or major ear surgery*
No
Yes
Sinus Conditions: Tumour, polyps, or cyst of the sinus cavities or nasal passages, major sinus surgery, or persistent sinus infection*
No
Yes
Asthma: History of asthma or asthma attacks. Any history of wheezing caused by exercise, anxiety, cold, fatigue, etc. Any condition requiring medication and/or use of an inhaler for control of wheezing*
No
Yes
Diabetes Mellitus: Especially Type I Diabetes (Insulin dependent) or Type II Diabetes, which requires insulin or oral medication for control. Any form of Diabetes that is unstable, "brittle" or produces episodes of hypoglycaemia (low blood sugar reactions), hyperglycaemia (extremely high blood sugar with ketosis) or if there is related kidney disease, eye disease, heart disease or blood vessel disease.*
No
Yes
Pregnancy (If YES we're afraid you can not participate): If you are presently pregnant or planning to be pregnant*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician*
No
Yes
Freediving/ Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air*
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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