Diver Medical

Participant Questionnaire

Recreational scuba diving and freediving requires good physical and mental health. This questionnaire helps determine if you should seek medical evaluation before diving.

Complete this questionnaire as a prerequisite to a recreational scuba diving or freediving course.

Note to women: If you are pregnant, or attempting to become pregnant, do not dive.

Full Name *

Email Address *

Phone Number *

Date of Birth *

Address *

Emergency Contact Name *

Emergency Contact Phone *

Terms & Conditions

Risk Acknowledgment for Diving Activities:

By participating in diving activities, you acknowledge and agree to the following terms and conditions:

Equipment and Instruction Requirements

You will use only approved diving equipment and follow all equipment safety guidelines
You will follow all instructions provided by certified diving professionals
You understand the importance of proper equipment maintenance and inspection

Medical Fitness Confirmation

You confirm that you are medically fit to participate in diving activities
You will disclose any medical conditions that may affect your safety during diving
You understand that certain medical conditions require physician approval

Age Restrictions and Supervision Requirements

Participants under 18 years of age must have parental/guardian consent
Minors must be accompanied by a parent/guardian during activities
All participants must meet minimum age requirements for specific diving programs

Liability Limitations

You understand that diving activities involve inherent risks
You participate in diving activities at your own risk
Blue Planet Aquarium's liability is limited as per applicable law

Full Name *

Address *

Signature *

Date *

* I have read and agree to the Terms & Conditions

Disclaimer and Indemnity Form

Blue Planet Aquarium Diving Activities - Legal Disclaimer

Acknowledgment of High-Risk Activity

I acknowledge that diving activities, whether recreational scuba diving, freediving, or snorkeling, are high-risk activities that involve inherent dangers and risks of serious injury or death.

Confirmation of Understanding Dangers and Risks

I understand and acknowledge that the risks associated with diving activities include, but are not limited to:

Decompression sickness (the bends)
Gas narcosis and oxygen toxicity
Equipment malfunction or failure
Entanglement, entrapment, or loss of air supply
Hypothermia and marine life encounters
Drowning and other water-related injuries

Indemnification Agreement

In consideration for being permitted to participate in diving activities at Blue Planet Aquarium, I agree to indemnify, defend, and hold harmless Blue Planet Aquarium, its employees, agents, contractors, and affiliated companies from any and all claims, damages, losses, or expenses arising from my participation in diving activities.

Agreement to Follow Instructions and Dive Plans

I agree to:

Follow all safety instructions and dive plans provided by certified instructors
Use only approved diving equipment and techniques
Remain within my certification limits and experience level
Immediately report any equipment problems or safety concerns
Follow emergency procedures if an incident occurs

Full Name *

Address *

Signature *

Date *

* I have read and agree to the Disclaimer and Indemnity

Diver Medical

Participant Questionnaire

Terms & Conditions

Equipment and Instruction Requirements

Medical Fitness Confirmation

Age Restrictions and Supervision Requirements

Liability Limitations

Disclaimer and Indemnity Form

Acknowledgment of High-Risk Activity

Confirmation of Understanding Dangers and Risks

Indemnification Agreement

Agreement to Follow Instructions and Dive Plans

Complete this questionnaire as a prerequisite to a recreational scuba diving or freediving course.

I have/have had:

I am over 45 years of age AND:

I have/have had:

I have/have had:

I have/have had:

I have/have had:

I have had:

A medical evaluation is required

A medical evaluation is not required

Participant Statement

Getting Here