FORMS

DISCOVER SCUBA DIVING REGISTRATION FORM

For Headquarters Use:
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STUDENT INFORMATION PLEASE PRINT CLEARLY - IN CAPITAL - ALL INFORMATION BELOW
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How did you find out about us - Please Choose
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To continue your Discover Diving experience, you must complete this review under the direction of your PADI Professional BEFORE getting in the water. Check the appropriate box in response to each question
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Participant Statement : I have had this Review explained to me and I now understand any questions I may have answered incorrectly. I acknowledge and accept that these practices are intended to increase my safety and comfort during the experience
PADI Discover Scuba Diving Participant Statement Please read the following paragraphs carefully and fill in all blanks before signing, This statement, which includes a Medical Questionnaire, Discover Scuba Diving Safe Practices Statement and a Statement of Risks and Liability, informs you of some potential risks involved in scuba diving and of the conduct required of you during the PADI Discover Scuba Diving programme. Your signature is required to participate in the programme. lf you are a minor, you must have the Participant Statement (which includes and acknowledges the Medical Questionnaire, the Discover Scuba Diving Safe Practices and the Statement of Risks and Liability) signed by your parent or guardian. You will also need to learn from the instructor the important safety rules regarding breathing and equalisation while scuba diving. lmproper use of scuba equipment can result in serious injury or death. You must be thoroughly instructed in its use under the direct supervision of a qualified instructor to use it safely. PADI Medical Questionnaire Scuba diving is an exciting and demanding activity. To scuba dive safely, you must not be extremely overweight or out of condition. Diving can be strenuous under certain conditions. Your respiratory and circulatory systems must be in good health. All body air spaces must be normal and healthy. A person with heart trouble, a current cold or congestion, epilepsy, asthma, a severe medical problem, or who is under the influence of alcohol or drugs, should not dive. lf taking medication, consult your doctor before participating in this programme. The purpose of this medical history questionnaire is to find out if a doctor should examine you before participating in recreational scuba diving. A positive response to a question does not necessarily disqualify you from diving. A positive response means that there is a pre-existing condition that may affect your safety while diving and you must seek the advice of a physician. Please answer the following questions on your past and present medical history with a YES or NO. lf you are not sure, answer YES. lf any of these items apply to you, we must request that you consult with a physician prior to participating in scuba diving. Your Instructor will supply you with a PADI Medical Statement and Guidelines for Recreational Scuba Diver's Physical Examination to take to a physician
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Discover Scuba Diving Knowledge and Safety Review
These practices have been compiled for your review and acknowledgment and are intended to increase your comfort and safety in diving. I understand that upon completing the Discover Scuba Diving programme, I will not be qualified to dive independently without a certified professional guiding me. To equalize my ears and sinus air spaces, I will need to blow gently against pinched nostrils every few feet/one metre while descending. lf I have discomfort in my ears or sinuses during descent, I should stop my descent and alert my instructor. Underwater, I should breathe slowly, deeply, continuously and never hold my breath. I should respect underwater life and not touch, tease or harass an underwater organism since it may harm me and/or I may harm it. I can seek further training from any PADI Dive Centre, Resort and instructor to become certified to dive without a professional guide
Statement of Risks and Liability I (participant name),
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hereby affirm that I am aware that skin and scuba diving have inherent risks which may result in serious injury or death. I affirm I have read and understand the Safe Diving Practices and have had any questions answered to my satisfaction. I understand the importance and purposes of these established practices. I recognise they are for my safety and well being, and that failure to adhere to them can place me in jeopardy when diving. I understand that diving with compressed air involves certain inherent risks; decompression sickness, embolism or other hyperbaric injury can occur that require treatment in a recompression chamber. I further understand that this programme may be conducted at a site that is remote, either by time or distance or both, from such a recompression chamber. I still choose to proceed with this programme in spite of the absence of a recompression chamber in proximity to the dive site. The information I have provided about my medical history on the Medical Questionnaire is accurate to the best of my knowledge. I agree to accept responsibility for omissions regarding my failure to disclose any existing or past health conditions. I further understand that skin diving and scuba diving are physically strenuous activities and that l will be exerting myself during this programme. I further state that I am of lawful age and legally competent to sign this Statement of Risks and Liability, or that I have acquired the written consent of my parent or guardian. Neither the teaching instructor(s), Kostas Sgourakis, the facility through which this training is offered, Mykonos Diving Center / Dive Adventures, PADI lnternational Ltd., or PADl Americas, lnc., accept any responsibility for any death, injury or other loss suffered or caused by me or resulting from my own conduct or any manner or condition under my control which amounts to my own contributory negligence. ln the absence of any negligence or other breach of duty by the teaching instructor(s) , Kostas Sgourakis, the facility through which this training is offered, Mykonos Diving Center / Dive Adventures , PADI lnternational Ltd., or PADl Americas, lnc., my participation in this diving course is entirely at my own risk.
I have fully informed myself of the contents of this Statement of Risks and Liability by reading it before signing it
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EMERGENCY CONTACT INFORMATION In case of emergency, contact: (Please supply as much information as you can)
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