Dolphins Pacific

For Paticipants who are willing to join Dolphin Dive or Dolphin Intro Dive

Read the following paragraphs carefully. This Statement, which includes a Medical Questionnaire, the Discover Scuba Diving Safe Diving Practices and a Liability Release and Assumption of Risk Agreement, informs you of some potential risks involved in scuba diving and of the conduct required of you during the PADI Discover Scuba Diving Program. Your signature is required in order to participate in the program. If you are a minor, you must have the Participant Statement (which includes and acknowledges the Medical Questionnaire, the Discover Scuba Diving Safe Diving Practices and the Liability Release and Assumption of Risk Agreement) signed by a parent or guardian.

You will also need to learn from the instructor the most important safety rules regarding breathing and equalization while scuba diving. Improper 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.

"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. If taking medication, consult your doctor before participating in this program.

The purpose of this 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. (If you are not sure, that mean Yes.) If any of these items apply to you, we must request that you consult with a physician prior to participating in scuba diving. Your instructor will supply you with a PADI Medical Statement and Guidelines for Recreational Scuba Diver's Physical Examination to take to a physician.

・Do you currentry have an ear infection?
・Do you have a history of ear disease, hearing less or problems with balance?
・Do you have a history of ear or sinus surgery?
・Are you currentry suffering from a cold, congestion, sinusitis or bronchitis?
・Do you have a history of respiratory problems, severe attacks of hayfever or allergies, or lung disease?
・Have you had a collapsed lung (pneumothorax) or history of chest surgery?
・Do you have active asthma or history of emphysema or tuberculosis?
・Are you currently taking medication that carries a warning about any impairment of your physical or mental abilities?
・Do you have behavioral health, mental or psychological problems or a nervous system disorder?
・Are you or could you be pregnant?
・Do you have a history of colostomy?
・Do you have a history of heart disease or heart attack, heart surgery or blood vessel surgery?
・Do you have a history of high blood pressure, angina, or take medication to control blood pressure?
・Are you over 45 and have a family history of heart attack or stroke?
・Do you have a history of bleeding or other blood disorders?
・Do you have a history of diabetes?
・Do you have a history of seizures, blackouts or fainting, convulsions or epilepsy or take medications to prevent them?
・Do you have a history of back, arm or leg problems following an injury, fracture or surgery?
・Do you have a history of fear of closed or open spaces or panic attacks (claustrophobia or agoraphobia)?

※The following extract is taken from PADI Discover Scuba Diving Participant Statement