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4 DAY & 3 NIGHT FREEDIVING TRIP

LIABILITY RELEASE AND ASSUMPTION OF RISK

I, PARTICIPANT, HEREBY DECLARE THAT I UNDERSTAND THAT FREEDIVING IS AN INHERENTLY RISKY ACTIVITY THAT MAY RESULT IN SERIOUS BODILY INJURY OR DEATH. I KNOWINGLY AND FREELY ACCEPT AND ASSUME ALL RESPONSIBILITY FOR MY PARTICIPATION IN FREEDIVING WITH INSTRUCTOR.

In consideration of INSTRUCTOR allowing me to participate in freediving activities in connection with PROSAIL QUEENSLAND PTY LTD. (“PROSAIL”), I hereby fully release and discharge from responsibility INSTRUCTOR and PROSAIL, and their respective officers, directors, agents, contractors and any other individuals connected to or acting on behalf of them (including, without limitation, volunteers and other participants)(collectively the “Released Parties”) from any and all liability, claims, losses or damages related to my participation in any freediving activity (whether such activity is in connection with PROSAIL or otherwise), including, without limitation, liability, claims, losses or damages resulting from the negligence of any party, including the Released Parties. I agree that if I, or anyone on my behalf, make any claim or demand against any Released Party in connection with my participation in any freediving activity, I will indemnify and hold harmless each such Released party from any loss, liability, damage or cost incurred as result of such claim or demand.

I declare that I am in good mental and proper physical condition to participate in freediving. I am not under the influence of alcohol or any drugs that are contraindicatory to freediving. I know of no reason why I cannot or should not freedive.

I am legally competent to sign this liability release. I understand the terms herein are contractual and not a mere recital, and that I have signed this document of my own free will and with the knowledge that I hereby agree to waive my legal rights. I further agree that if any provision of this Liability Release and Assumption of Risk is found to be unenforceable or invalid that provision shall be severed and the remainder of this document will then be construed as though the unenforceable provision was not contained herein. 

Today's Date: January 28, 2023


STINGER SUIT WAIVER 

Definitions: "Operator" in this Waiver means and refers to the company Prosail QLD Pty Ltd. 

 I do hereby acknowledge that: 

  1. I have been advised of the risk for being stung by marine stingers. 
  2. I have been advised to wear a Stinger suit (or full length wetsuit) for my own protection. 
  3. It is in my own free will and desire, that I do not wish to wear a Stinger suit, and I, therefore, put myself at risk during the next three or four days. I do so at my own risk and I accept full responsibility for any injury. 
  4. I am fully aware that should I be stung by a marine stinger, I am hereby releasing the crew and the operator of Prosail QLD Pty Ltd of any liability arising from any action taken in treating my injury. I am fully aware that there is no qualified medical staff on the vessel and it may take considerable time to organise either transport to a hospital or to organise a doctor to attend to my injury. 
  5. Agree to indemnify and otherwise hold harmless, the operator, its directors, servants or agents from all and any courses of action, whether for damages, compensation or any other orders whatsoever, whether at common law, in equity, under statute or otherwise however and whatsoever, whether arising from the negligence and / or breach of contract on the part of the operator, its directors, officers, servants or agents.

Prosail QLD Pty Ltd hereby accepts the benefits clause (ii) above in all respects and hereby accepts the promises made by the participant therein. 

Yes, I accept these Safety Terms

January 28, 2023



ASSUMPTION AND ACKNOWLEDGEMENT OF RISKS AND RELEASE OF LIABILITY AGREEMENT 

In consideration of being allowed to participate in water sport events and activities and/or provided with water sport recreation property or services for myself, and my /our heirs, personal representative or assigns. 

I acknowledge that some, but not all, of the risk of participating in the water sport activity include: (1) changing water flow, tides, currents, wave action, and ship’s wakes; (2) collision with any of the following: other participants, the watercraft, other watercraft and man-made or natural objects; (3) wind shear, inclement weather, lightning, variances and extremes of wind, weather and temperatures ; (4) my sense of balance, physical coordination, ability to operate equipment, swim and/or follow direction; (5) collision, capsizing, sinking or other hazard which results in wetness, injury, exposure to the elements, hypothermia, impact of the body upon the water, injection of water into my body orifices and/or drowning; (6) the presence of insects and marine life forms; (7) equipment failure or operator error: (8) heat or sun related injuries or illness, including sunburn, sun stroke or dehydration; (9) fatigue, chill and/or dizziness which may diminish my/our reaction time and increase the risk of accident. 

I agree to assume responsibility for all risk of the activity, whether identified above or not, (even those risk arising out of negligence of Prosail QLD Pty Ltd). My/our participation in this activity is purely voluntary. I assume full responsibility for myself, for any bodily injury, illness, paralysis, death, loss of property and the expenses thereof as a result of any accident which may occur while I/we participate in the activity (even if caused, in whole or in part by the negligence of Prosail QLD Pty Ltd). I agree to wear Aust Standard personal floatation device (life jacket) if required while participating in the activity or riding any watercraft. 

I hereby release Prosail QLD Pty Ltd, its principals, directors, officers, agents, employees and volunteers, their insurers and each and every land owner, municipal and /or governmental agency upon whose property an activity is conducted (“owner”) and their insurers, if any, (Collectively releases) from any and all liability of any nature for any and all injury or damage (including death) to me or other persons as a result of my/our participation in the activity, even if caused by negligence, of any of the releasees named above or any other person (including myself). 

I have read this assumption and acknowledgement of risk and release of liability agreement. I understand that by signing this document I am waiving valuable legal rights, including any and all I may have against the owner, the operator named above or their employees, agents, servants or assigns. 

I authorise Prosail Qld Pty Ltd to supply my personal information to Medical Authorities and Police in the event of an unforeseen accident. I understand that the Skipper of the vessel will do his/her best to visit the major icons of the Whitsundays. The itinerary may change based on professional judgement, guest comfort and safety. 

I understand that Prosail QLD Pty Ltd is not a common carrier and accepts no liability for loss, damage or injury to any passenger, personal effects or luggage. 

I give Authority to Prosail QLD Pty Ltd to use any photographs taken by Crew for promotional material. 

January 28, 2023


First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Gender
Female
Male
Transgender
Non-binary/non-conforming
Prefer not to respond

Home Country
Dietary requirements
No dietary requirements
Vegetarian (no fish)
Vegetarian (fish ok)
Vegan
Don't eat fish
Lactose Intolerant
Gluten free
Other - please explain below

Other

Emergency contact person (do not list anyone who is on this trip with you)

Emergency contact persons phone number
If you would like us to provide a snorkel suit/wetsuit for you, please let us know your size. **Please note, if you are bringing along your own, you will need a full length suit to help protect you from marine stingers
No thanks, I will be bringing along my own
XS
S
M
L
XL
XXL
Where did you hear about us?
Social media
Brochure
Prosail website
Booking website
Accommodation / Concierge
Return customer
Travel agent
Referal
Walked past
Other

Other
I would also be interested in
Spearfishing trips
Yoga retreats
Photography workshop retreats
Our 3 day/2 night Whitsunday Islands tours
Our 4 day/3 night Whitsunday Island and outer reef tours
None of the above

MEDICAL QUESTIONNAIRE

The purpose of this Medical Questionnaire is to determine if you should be examined by your doctor before participating in freedive activities. A positive (i.e. “YES”) response to a question does not necessarily disqualify you from freediving. A positive response means that there is a pre-existing condition that may affect your safety while freediving and you MUST seek the advice of a physician prior to engaging in freedive activities. You must provide a signed form from the physician to say that they find no medical conditions incompatible with freediving if any “YES” box is ticked.

Please answer the following questions about your past and present medical history by ticking the box marked YES or NO. If you are not sure, answer YES

Neurological Conditions: 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: Especially heart attack, heart surgery, irregular heartbeat, uncontrolled elevated blood pressure. *
No
Yes
Pulmonary Conditions: 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: Tumor, 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 hypoglycemia (low blood sugar reactions), hyperglycemia (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 you are presently pregnant or planning to be pregnant. *
No
Yes
Freediving / Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air.*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician. *
No
Yes
General Medical Problems: Any physical and/or emotional condition not mentioned that might affect your safety in an underwater environment or affect your judgment under times of physical or emotional stress. *
No
Yes
A positive test for Covid-19 anytime in your past, especially if the infection was associated with any symptoms, or if you currently suffer from symptoms generally associated with a Covid-19 infection.*
No
Yes

I, certify that I have answered the above questions accurately and honestly. I also declare that I will be freediving within the levels of my experience, competence and training with a competent buddy at all times.

First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Gender
Female
Male
Transgender
Non-binary/non-conforming
Prefer not to respond

Home Country
Dietary requirements
No dietary requirements
Vegetarian (no fish)
Vegetarian (fish ok)
Vegan
Don't eat fish
Lactose Intolerant
Gluten free
Other - please explain below

Other

Emergency contact person (do not list anyone who is on this trip with you)

Emergency contact persons phone number
If you would like us to provide a snorkel suit/wetsuit for you, please let us know your size. **Please note, if you are bringing along your own, you will need a full length suit to help protect you from marine stingers
No thanks, I will be bringing along my own
XS
S
M
L
XL
XXL
Where did you hear about us?
Social media
Brochure
Prosail website
Booking website
Accommodation / Concierge
Return customer
Travel agent
Referal
Walked past
Other

Other
I would also be interested in
Spearfishing trips
Yoga retreats
Photography workshop retreats
Our 3 day/2 night Whitsunday Islands tours
Our 4 day/3 night Whitsunday Island and outer reef tours
None of the above

MEDICAL QUESTIONNAIRE

The purpose of this Medical Questionnaire is to determine if you should be examined by your doctor before participating in freedive activities. A positive (i.e. “YES”) response to a question does not necessarily disqualify you from freediving. A positive response means that there is a pre-existing condition that may affect your safety while freediving and you MUST seek the advice of a physician prior to engaging in freedive activities. You must provide a signed form from the physician to say that they find no medical conditions incompatible with freediving if any “YES” box is ticked.

Please answer the following questions about your past and present medical history by ticking the box marked YES or NO. If you are not sure, answer YES

Neurological Conditions: 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: Especially heart attack, heart surgery, irregular heartbeat, uncontrolled elevated blood pressure. *
No
Yes
Pulmonary Conditions: 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: Tumor, 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 hypoglycemia (low blood sugar reactions), hyperglycemia (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 you are presently pregnant or planning to be pregnant. *
No
Yes
Freediving / Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air.*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician. *
No
Yes
General Medical Problems: Any physical and/or emotional condition not mentioned that might affect your safety in an underwater environment or affect your judgment under times of physical or emotional stress. *
No
Yes
A positive test for Covid-19 anytime in your past, especially if the infection was associated with any symptoms, or if you currently suffer from symptoms generally associated with a Covid-19 infection.*
No
Yes

I, certify that I have answered the above questions accurately and honestly. I also declare that I will be freediving within the levels of my experience, competence and training with a competent buddy at all times.

Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Gender
Female
Male
Transgender
Non-binary/non-conforming
Prefer not to respond

Home Country
Dietary requirements
No dietary requirements
Vegetarian (no fish)
Vegetarian (fish ok)
Vegan
Don't eat fish
Lactose Intolerant
Gluten free
Other - please explain below

Other

Emergency contact person (do not list anyone who is on this trip with you)

Emergency contact persons phone number
If you would like us to provide a snorkel suit/wetsuit for you, please let us know your size. **Please note, if you are bringing along your own, you will need a full length suit to help protect you from marine stingers
No thanks, I will be bringing along my own
XS
S
M
L
XL
XXL
Where did you hear about us?
Social media
Brochure
Prosail website
Booking website
Accommodation / Concierge
Return customer
Travel agent
Referal
Walked past
Other

Other
I would also be interested in
Spearfishing trips
Yoga retreats
Photography workshop retreats
Our 3 day/2 night Whitsunday Islands tours
Our 4 day/3 night Whitsunday Island and outer reef tours
None of the above

MEDICAL QUESTIONNAIRE

The purpose of this Medical Questionnaire is to determine if you should be examined by your doctor before participating in freedive activities. A positive (i.e. “YES”) response to a question does not necessarily disqualify you from freediving. A positive response means that there is a pre-existing condition that may affect your safety while freediving and you MUST seek the advice of a physician prior to engaging in freedive activities. You must provide a signed form from the physician to say that they find no medical conditions incompatible with freediving if any “YES” box is ticked.

Please answer the following questions about your past and present medical history by ticking the box marked YES or NO. If you are not sure, answer YES

Neurological Conditions: 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: Especially heart attack, heart surgery, irregular heartbeat, uncontrolled elevated blood pressure. *
No
Yes
Pulmonary Conditions: 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: Tumor, 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 hypoglycemia (low blood sugar reactions), hyperglycemia (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 you are presently pregnant or planning to be pregnant. *
No
Yes
Freediving / Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air.*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician. *
No
Yes
General Medical Problems: Any physical and/or emotional condition not mentioned that might affect your safety in an underwater environment or affect your judgment under times of physical or emotional stress. *
No
Yes
A positive test for Covid-19 anytime in your past, especially if the infection was associated with any symptoms, or if you currently suffer from symptoms generally associated with a Covid-19 infection.*
No
Yes

I, certify that I have answered the above questions accurately and honestly. I also declare that I will be freediving within the levels of my experience, competence and training with a competent buddy at all times.

Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Gender
Female
Male
Transgender
Non-binary/non-conforming
Prefer not to respond

Home Country
Dietary requirements
No dietary requirements
Vegetarian (no fish)
Vegetarian (fish ok)
Vegan
Don't eat fish
Lactose Intolerant
Gluten free
Other - please explain below

Other

Emergency contact person (do not list anyone who is on this trip with you)

Emergency contact persons phone number
If you would like us to provide a snorkel suit/wetsuit for you, please let us know your size. **Please note, if you are bringing along your own, you will need a full length suit to help protect you from marine stingers
No thanks, I will be bringing along my own
XS
S
M
L
XL
XXL
Where did you hear about us?
Social media
Brochure
Prosail website
Booking website
Accommodation / Concierge
Return customer
Travel agent
Referal
Walked past
Other

Other
I would also be interested in
Spearfishing trips
Yoga retreats
Photography workshop retreats
Our 3 day/2 night Whitsunday Islands tours
Our 4 day/3 night Whitsunday Island and outer reef tours
None of the above

MEDICAL QUESTIONNAIRE

The purpose of this Medical Questionnaire is to determine if you should be examined by your doctor before participating in freedive activities. A positive (i.e. “YES”) response to a question does not necessarily disqualify you from freediving. A positive response means that there is a pre-existing condition that may affect your safety while freediving and you MUST seek the advice of a physician prior to engaging in freedive activities. You must provide a signed form from the physician to say that they find no medical conditions incompatible with freediving if any “YES” box is ticked.

Please answer the following questions about your past and present medical history by ticking the box marked YES or NO. If you are not sure, answer YES

Neurological Conditions: 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: Especially heart attack, heart surgery, irregular heartbeat, uncontrolled elevated blood pressure. *
No
Yes
Pulmonary Conditions: 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: Tumor, 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 hypoglycemia (low blood sugar reactions), hyperglycemia (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 you are presently pregnant or planning to be pregnant. *
No
Yes
Freediving / Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air.*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician. *
No
Yes
General Medical Problems: Any physical and/or emotional condition not mentioned that might affect your safety in an underwater environment or affect your judgment under times of physical or emotional stress. *
No
Yes
A positive test for Covid-19 anytime in your past, especially if the infection was associated with any symptoms, or if you currently suffer from symptoms generally associated with a Covid-19 infection.*
No
Yes

I, certify that I have answered the above questions accurately and honestly. I also declare that I will be freediving within the levels of my experience, competence and training with a competent buddy at all times.

Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Gender
Female
Male
Transgender
Non-binary/non-conforming
Prefer not to respond

Home Country
Dietary requirements
No dietary requirements
Vegetarian (no fish)
Vegetarian (fish ok)
Vegan
Don't eat fish
Lactose Intolerant
Gluten free
Other - please explain below

Other

Emergency contact person (do not list anyone who is on this trip with you)

Emergency contact persons phone number
If you would like us to provide a snorkel suit/wetsuit for you, please let us know your size. **Please note, if you are bringing along your own, you will need a full length suit to help protect you from marine stingers
No thanks, I will be bringing along my own
XS
S
M
L
XL
XXL
Where did you hear about us?
Social media
Brochure
Prosail website
Booking website
Accommodation / Concierge
Return customer
Travel agent
Referal
Walked past
Other

Other
I would also be interested in
Spearfishing trips
Yoga retreats
Photography workshop retreats
Our 3 day/2 night Whitsunday Islands tours
Our 4 day/3 night Whitsunday Island and outer reef tours
None of the above

MEDICAL QUESTIONNAIRE

The purpose of this Medical Questionnaire is to determine if you should be examined by your doctor before participating in freedive activities. A positive (i.e. “YES”) response to a question does not necessarily disqualify you from freediving. A positive response means that there is a pre-existing condition that may affect your safety while freediving and you MUST seek the advice of a physician prior to engaging in freedive activities. You must provide a signed form from the physician to say that they find no medical conditions incompatible with freediving if any “YES” box is ticked.

Please answer the following questions about your past and present medical history by ticking the box marked YES or NO. If you are not sure, answer YES

Neurological Conditions: 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: Especially heart attack, heart surgery, irregular heartbeat, uncontrolled elevated blood pressure. *
No
Yes
Pulmonary Conditions: 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: Tumor, 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 hypoglycemia (low blood sugar reactions), hyperglycemia (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 you are presently pregnant or planning to be pregnant. *
No
Yes
Freediving / Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air.*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician. *
No
Yes
General Medical Problems: Any physical and/or emotional condition not mentioned that might affect your safety in an underwater environment or affect your judgment under times of physical or emotional stress. *
No
Yes
A positive test for Covid-19 anytime in your past, especially if the infection was associated with any symptoms, or if you currently suffer from symptoms generally associated with a Covid-19 infection.*
No
Yes

I, certify that I have answered the above questions accurately and honestly. I also declare that I will be freediving within the levels of my experience, competence and training with a competent buddy at all times.

Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Gender
Female
Male
Transgender
Non-binary/non-conforming
Prefer not to respond

Home Country
Dietary requirements
No dietary requirements
Vegetarian (no fish)
Vegetarian (fish ok)
Vegan
Don't eat fish
Lactose Intolerant
Gluten free
Other - please explain below

Other

Emergency contact person (do not list anyone who is on this trip with you)

Emergency contact persons phone number
If you would like us to provide a snorkel suit/wetsuit for you, please let us know your size. **Please note, if you are bringing along your own, you will need a full length suit to help protect you from marine stingers
No thanks, I will be bringing along my own
XS
S
M
L
XL
XXL
Where did you hear about us?
Social media
Brochure
Prosail website
Booking website
Accommodation / Concierge
Return customer
Travel agent
Referal
Walked past
Other

Other
I would also be interested in
Spearfishing trips
Yoga retreats
Photography workshop retreats
Our 3 day/2 night Whitsunday Islands tours
Our 4 day/3 night Whitsunday Island and outer reef tours
None of the above

MEDICAL QUESTIONNAIRE

The purpose of this Medical Questionnaire is to determine if you should be examined by your doctor before participating in freedive activities. A positive (i.e. “YES”) response to a question does not necessarily disqualify you from freediving. A positive response means that there is a pre-existing condition that may affect your safety while freediving and you MUST seek the advice of a physician prior to engaging in freedive activities. You must provide a signed form from the physician to say that they find no medical conditions incompatible with freediving if any “YES” box is ticked.

Please answer the following questions about your past and present medical history by ticking the box marked YES or NO. If you are not sure, answer YES

Neurological Conditions: 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: Especially heart attack, heart surgery, irregular heartbeat, uncontrolled elevated blood pressure. *
No
Yes
Pulmonary Conditions: 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: Tumor, 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 hypoglycemia (low blood sugar reactions), hyperglycemia (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 you are presently pregnant or planning to be pregnant. *
No
Yes
Freediving / Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air.*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician. *
No
Yes
General Medical Problems: Any physical and/or emotional condition not mentioned that might affect your safety in an underwater environment or affect your judgment under times of physical or emotional stress. *
No
Yes
A positive test for Covid-19 anytime in your past, especially if the infection was associated with any symptoms, or if you currently suffer from symptoms generally associated with a Covid-19 infection.*
No
Yes

I, certify that I have answered the above questions accurately and honestly. I also declare that I will be freediving within the levels of my experience, competence and training with a competent buddy at all times.

Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Gender
Female
Male
Transgender
Non-binary/non-conforming
Prefer not to respond

Home Country
Dietary requirements
No dietary requirements
Vegetarian (no fish)
Vegetarian (fish ok)
Vegan
Don't eat fish
Lactose Intolerant
Gluten free
Other - please explain below

Other

Emergency contact person (do not list anyone who is on this trip with you)

Emergency contact persons phone number
If you would like us to provide a snorkel suit/wetsuit for you, please let us know your size. **Please note, if you are bringing along your own, you will need a full length suit to help protect you from marine stingers
No thanks, I will be bringing along my own
XS
S
M
L
XL
XXL
Where did you hear about us?
Social media
Brochure
Prosail website
Booking website
Accommodation / Concierge
Return customer
Travel agent
Referal
Walked past
Other

Other
I would also be interested in
Spearfishing trips
Yoga retreats
Photography workshop retreats
Our 3 day/2 night Whitsunday Islands tours
Our 4 day/3 night Whitsunday Island and outer reef tours
None of the above

MEDICAL QUESTIONNAIRE

The purpose of this Medical Questionnaire is to determine if you should be examined by your doctor before participating in freedive activities. A positive (i.e. “YES”) response to a question does not necessarily disqualify you from freediving. A positive response means that there is a pre-existing condition that may affect your safety while freediving and you MUST seek the advice of a physician prior to engaging in freedive activities. You must provide a signed form from the physician to say that they find no medical conditions incompatible with freediving if any “YES” box is ticked.

Please answer the following questions about your past and present medical history by ticking the box marked YES or NO. If you are not sure, answer YES

Neurological Conditions: 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: Especially heart attack, heart surgery, irregular heartbeat, uncontrolled elevated blood pressure. *
No
Yes
Pulmonary Conditions: 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: Tumor, 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 hypoglycemia (low blood sugar reactions), hyperglycemia (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 you are presently pregnant or planning to be pregnant. *
No
Yes
Freediving / Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air.*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician. *
No
Yes
General Medical Problems: Any physical and/or emotional condition not mentioned that might affect your safety in an underwater environment or affect your judgment under times of physical or emotional stress. *
No
Yes
A positive test for Covid-19 anytime in your past, especially if the infection was associated with any symptoms, or if you currently suffer from symptoms generally associated with a Covid-19 infection.*
No
Yes

I, certify that I have answered the above questions accurately and honestly. I also declare that I will be freediving within the levels of my experience, competence and training with a competent buddy at all times.

Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Gender
Female
Male
Transgender
Non-binary/non-conforming
Prefer not to respond

Home Country
Dietary requirements
No dietary requirements
Vegetarian (no fish)
Vegetarian (fish ok)
Vegan
Don't eat fish
Lactose Intolerant
Gluten free
Other - please explain below

Other

Emergency contact person (do not list anyone who is on this trip with you)

Emergency contact persons phone number
If you would like us to provide a snorkel suit/wetsuit for you, please let us know your size. **Please note, if you are bringing along your own, you will need a full length suit to help protect you from marine stingers
No thanks, I will be bringing along my own
XS
S
M
L
XL
XXL
Where did you hear about us?
Social media
Brochure
Prosail website
Booking website
Accommodation / Concierge
Return customer
Travel agent
Referal
Walked past
Other

Other
I would also be interested in
Spearfishing trips
Yoga retreats
Photography workshop retreats
Our 3 day/2 night Whitsunday Islands tours
Our 4 day/3 night Whitsunday Island and outer reef tours
None of the above

MEDICAL QUESTIONNAIRE

The purpose of this Medical Questionnaire is to determine if you should be examined by your doctor before participating in freedive activities. A positive (i.e. “YES”) response to a question does not necessarily disqualify you from freediving. A positive response means that there is a pre-existing condition that may affect your safety while freediving and you MUST seek the advice of a physician prior to engaging in freedive activities. You must provide a signed form from the physician to say that they find no medical conditions incompatible with freediving if any “YES” box is ticked.

Please answer the following questions about your past and present medical history by ticking the box marked YES or NO. If you are not sure, answer YES

Neurological Conditions: 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: Especially heart attack, heart surgery, irregular heartbeat, uncontrolled elevated blood pressure. *
No
Yes
Pulmonary Conditions: 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: Tumor, 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 hypoglycemia (low blood sugar reactions), hyperglycemia (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 you are presently pregnant or planning to be pregnant. *
No
Yes
Freediving / Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air.*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician. *
No
Yes
General Medical Problems: Any physical and/or emotional condition not mentioned that might affect your safety in an underwater environment or affect your judgment under times of physical or emotional stress. *
No
Yes
A positive test for Covid-19 anytime in your past, especially if the infection was associated with any symptoms, or if you currently suffer from symptoms generally associated with a Covid-19 infection.*
No
Yes

I, certify that I have answered the above questions accurately and honestly. I also declare that I will be freediving within the levels of my experience, competence and training with a competent buddy at all times.

Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Gender
Female
Male
Transgender
Non-binary/non-conforming
Prefer not to respond

Home Country
Dietary requirements
No dietary requirements
Vegetarian (no fish)
Vegetarian (fish ok)
Vegan
Don't eat fish
Lactose Intolerant
Gluten free
Other - please explain below

Other

Emergency contact person (do not list anyone who is on this trip with you)

Emergency contact persons phone number
If you would like us to provide a snorkel suit/wetsuit for you, please let us know your size. **Please note, if you are bringing along your own, you will need a full length suit to help protect you from marine stingers
No thanks, I will be bringing along my own
XS
S
M
L
XL
XXL
Where did you hear about us?
Social media
Brochure
Prosail website
Booking website
Accommodation / Concierge
Return customer
Travel agent
Referal
Walked past
Other

Other
I would also be interested in
Spearfishing trips
Yoga retreats
Photography workshop retreats
Our 3 day/2 night Whitsunday Islands tours
Our 4 day/3 night Whitsunday Island and outer reef tours
None of the above

MEDICAL QUESTIONNAIRE

The purpose of this Medical Questionnaire is to determine if you should be examined by your doctor before participating in freedive activities. A positive (i.e. “YES”) response to a question does not necessarily disqualify you from freediving. A positive response means that there is a pre-existing condition that may affect your safety while freediving and you MUST seek the advice of a physician prior to engaging in freedive activities. You must provide a signed form from the physician to say that they find no medical conditions incompatible with freediving if any “YES” box is ticked.

Please answer the following questions about your past and present medical history by ticking the box marked YES or NO. If you are not sure, answer YES

Neurological Conditions: 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: Especially heart attack, heart surgery, irregular heartbeat, uncontrolled elevated blood pressure. *
No
Yes
Pulmonary Conditions: 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: Tumor, 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 hypoglycemia (low blood sugar reactions), hyperglycemia (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 you are presently pregnant or planning to be pregnant. *
No
Yes
Freediving / Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air.*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician. *
No
Yes
General Medical Problems: Any physical and/or emotional condition not mentioned that might affect your safety in an underwater environment or affect your judgment under times of physical or emotional stress. *
No
Yes
A positive test for Covid-19 anytime in your past, especially if the infection was associated with any symptoms, or if you currently suffer from symptoms generally associated with a Covid-19 infection.*
No
Yes

I, certify that I have answered the above questions accurately and honestly. I also declare that I will be freediving within the levels of my experience, competence and training with a competent buddy at all times.

Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Gender
Female
Male
Transgender
Non-binary/non-conforming
Prefer not to respond

Home Country
Dietary requirements
No dietary requirements
Vegetarian (no fish)
Vegetarian (fish ok)
Vegan
Don't eat fish
Lactose Intolerant
Gluten free
Other - please explain below

Other

Emergency contact person (do not list anyone who is on this trip with you)

Emergency contact persons phone number
If you would like us to provide a snorkel suit/wetsuit for you, please let us know your size. **Please note, if you are bringing along your own, you will need a full length suit to help protect you from marine stingers
No thanks, I will be bringing along my own
XS
S
M
L
XL
XXL
Where did you hear about us?
Social media
Brochure
Prosail website
Booking website
Accommodation / Concierge
Return customer
Travel agent
Referal
Walked past
Other

Other
I would also be interested in
Spearfishing trips
Yoga retreats
Photography workshop retreats
Our 3 day/2 night Whitsunday Islands tours
Our 4 day/3 night Whitsunday Island and outer reef tours
None of the above

MEDICAL QUESTIONNAIRE

The purpose of this Medical Questionnaire is to determine if you should be examined by your doctor before participating in freedive activities. A positive (i.e. “YES”) response to a question does not necessarily disqualify you from freediving. A positive response means that there is a pre-existing condition that may affect your safety while freediving and you MUST seek the advice of a physician prior to engaging in freedive activities. You must provide a signed form from the physician to say that they find no medical conditions incompatible with freediving if any “YES” box is ticked.

Please answer the following questions about your past and present medical history by ticking the box marked YES or NO. If you are not sure, answer YES

Neurological Conditions: 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: Especially heart attack, heart surgery, irregular heartbeat, uncontrolled elevated blood pressure. *
No
Yes
Pulmonary Conditions: 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: Tumor, 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 hypoglycemia (low blood sugar reactions), hyperglycemia (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 you are presently pregnant or planning to be pregnant. *
No
Yes
Freediving / Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air.*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician. *
No
Yes
General Medical Problems: Any physical and/or emotional condition not mentioned that might affect your safety in an underwater environment or affect your judgment under times of physical or emotional stress. *
No
Yes
A positive test for Covid-19 anytime in your past, especially if the infection was associated with any symptoms, or if you currently suffer from symptoms generally associated with a Covid-19 infection.*
No
Yes

I, certify that I have answered the above questions accurately and honestly. I also declare that I will be freediving within the levels of my experience, competence and training with a competent buddy at all times.

Parent or Guardian's Email Address

Email*

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

Parental or Guardian’s Consent (required if PARTICIPANT is under 18 years of age). The undersigned, as the legal parent or guardian of PARTICIPANT, hereby grants permission to PARTICIPANT to participate in freediving activities in connection with the PROSAIL. The undersigned further agrees to all terms of this Liability Release and Assumption of Risk on behalf of PARTICIPANT and to indemnify and hold harmless the Released Parties from any liabilities incident to PARTICIPANT’s involvement or participation in such activities.



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
Gender
Female
Male
Transgender
Non-binary/non-conforming
Prefer not to respond

Home Country
Dietary requirements
No dietary requirements
Vegetarian (no fish)
Vegetarian (fish ok)
Vegan
Don't eat fish
Lactose Intolerant
Gluten free
Other - please explain below

Other

Emergency contact person (do not list anyone who is on this trip with you)

Emergency contact persons phone number
If you would like us to provide a snorkel suit/wetsuit for you, please let us know your size. **Please note, if you are bringing along your own, you will need a full length suit to help protect you from marine stingers
No thanks, I will be bringing along my own
XS
S
M
L
XL
XXL
Where did you hear about us?
Social media
Brochure
Prosail website
Booking website
Accommodation / Concierge
Return customer
Travel agent
Referal
Walked past
Other

Other
I would also be interested in
Spearfishing trips
Yoga retreats
Photography workshop retreats
Our 3 day/2 night Whitsunday Islands tours
Our 4 day/3 night Whitsunday Island and outer reef tours
None of the above

MEDICAL QUESTIONNAIRE

The purpose of this Medical Questionnaire is to determine if you should be examined by your doctor before participating in freedive activities. A positive (i.e. “YES”) response to a question does not necessarily disqualify you from freediving. A positive response means that there is a pre-existing condition that may affect your safety while freediving and you MUST seek the advice of a physician prior to engaging in freedive activities. You must provide a signed form from the physician to say that they find no medical conditions incompatible with freediving if any “YES” box is ticked.

Please answer the following questions about your past and present medical history by ticking the box marked YES or NO. If you are not sure, answer YES

Neurological Conditions: 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: Especially heart attack, heart surgery, irregular heartbeat, uncontrolled elevated blood pressure. *
No
Yes
Pulmonary Conditions: 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: Tumor, 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 hypoglycemia (low blood sugar reactions), hyperglycemia (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 you are presently pregnant or planning to be pregnant. *
No
Yes
Freediving / Scuba Diving Conditions: Previous history of a diving accident, decompression sickness, decompression of the inner ear of air.*
No
Yes
Medication: Any medication taken on a regular basis either over-the-counter or prescribed by a physician. *
No
Yes
General Medical Problems: Any physical and/or emotional condition not mentioned that might affect your safety in an underwater environment or affect your judgment under times of physical or emotional stress. *
No
Yes
A positive test for Covid-19 anytime in your past, especially if the infection was associated with any symptoms, or if you currently suffer from symptoms generally associated with a Covid-19 infection.*
No
Yes

I, certify that I have answered the above questions accurately and honestly. I also declare that I will be freediving within the levels of my experience, competence and training with a competent buddy at all times.

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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