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Discover Scuba Diving
Statement of Risks and Liability- Scuba Diving Trips and Boat Travel
PADI Discover Scuba® Diving Participant Statement
Read the following paragraphs carefully.
This statement, which includes a Medical Questionnaire, a Liability Release and Assumption of Risk Agreement (Statement of Risks and Liability), Non-Agency Disclosure and Acknowledgment and the Discover Scuba Diving Knowledge and Safety Review, informs you of some potential risks involved in scuba diving and of the conduct required of you during the PADI Discover Scuba Diving program. If you are a minor, your parent or guardian must read this Guide and sign on the back panel.
You will also need to learn important safety rules regarding breathing and equalization while scuba diving from the PADI Professional. Scuba diving and the use of scuba equipment without proper supervision or instruction can result in serious injury or death. You must be instructed in its use under the direct supervision of a qualified instructor.
PADI Medical Questionnaire
Scuba diving is an exciting and demanding activity. To scuba dive 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. If taking medication, consult your doctor before participating in this program.
The purpose of the Medical Questionnaire is to find out if you should be examined by a physician 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 preexisting condition that may affect your safety while diving and you must seek the advice of a physician.
Please answer the following questions on your past and present medical history with a YES or NO. If you are not sure, answer YES. If any of these items apply to you, we must request that you consult with a physician prior to participating in scuba diving. Your PADI Professional will supply you with a PADI Medical Statement and Guidelines for Recreational Scuba Diver’s Physical Examination to take to a physician.
Do you currently have an ear infection?
Yes
No
Do you have a history of ear disease, hearing loss or problems with balance?
Yes
No
Do you have a history of ear or sinus surgery?
Yes
No
Are you currently suffering from a cold, congestion, sinusitis or bronchitis?
Yes
No
Do you have a history of respiratory problems, severe attacks of hayfever or allergies, or lung disease?
Yes
No
Have you had a collapsed lung (pneumothorax) or history of chest surgery?
Yes
No
Do you have active asthma or history of emphysema or tuberculosis?
Yes
No
Are you currently taking medication that carries a warning about any impairment of your physical or mental abilities?
Yes
No
Do you have behavioral health, mental or psychological problems or a nervous system disorder?
Yes
No
Are you or could you be pregnant?
Yes
No
Do you have a history of colostomy?
Yes
No
Do you have a history of heart disease or heart attack, heart surgery or blood vessel surgery?
Yes
No
Do you have a history of high blood pressure, angina, or take medication to control blood pressure?
Yes
No
Are you over 45 and have a family history of heart attack or stroke?
Yes
No
Do you have a history of bleeding or other blood disorders?
Yes
No
Do you have a history of diabetes?
Yes
No
Do you have a history of seizures, blackouts or fainting, convulsions or epilepsy or take medications to prevent them?
Yes
No
Do you have a history of back, arm or leg problems following an injury, fracture or surgery?
Yes
No
Do you have a history of fear of closed or open spaces or panic attacks (claustrophobia or agoraphobia)?
Yes
No
Non-Agency Disclosure and Acknowledgment Agreement
Non-Agency Disclosure and Acknowledgment Agreement
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