Medical Information
To dive safely, you don't have to be excessively overweight or out of shape. Diving can be tiring under certain conditions. Your circulatory and respiratory systems must be healthy. All air cavities in the body must be normal and healthy. A person with a heart problem, a cold or an ongoing congestion, epilepsy, asthma, a serious medical problem or who is under the influence of alcohol or drugs should not dive. If you are taking medicines, have asthma, heart problems, other chronic diseases, consult your doctor and instructor before participating in this program and maintain an acceptable physical shape. If there is important information for the Sea Spirit Diving Resort, please contact one of our diving instructors.
2.ASKS To be admitted as a member of the sports club "Sea Spirit SSD ARL" for scuba diving, scuba courses, snorkeling P.IVA 03402030831 - Sede in Via Recanati 26, Giardini-Naxos (ME)
DECLARES to be aware that the structure within which it performs sporting practice is constituted legally in the form of non-profit sports club with limited liability and is recognized by CONI.
DECLARES also to have accepted the insurance policy for personal injuries provided by the affiliation of the company to protect its practitioners in the performance of institutional activities. The affiliated then declares to relieve the company itself of any compensation, even partial, not recognized or partially reimbursed by the insurance company concerned, for accidents and injuries that may occur before, during and after the activities. Declares to have understood the information on the use of personal data, pursuant to Article 13 of Legislative Decree No. 196 of June 30, 2003, containing the new code regarding the protection of personal data. It allows their treatment to the extent necessary for the pursuit of statutory and institutional purposes. Pursuant to article 13 of the
legislative decree n ° 196/2003, containing provisions on the new code regarding the protection of personal data, declares to be aware that the data provided will be processed in compliance with the aforementioned law and the confidentiality obligations, which will be treated only for institutional activities, therefore, strictly connected to the statutory activities and that the treatment will take place through the use of electronic or paper support, suitable to guarantee the security and confidentiality of the same. In relation to the aforementioned treatments, which may exercise the rights referred to in art. 7 of the d. lgs. N ° 196/2003 (cancellation, modification, opposition to treatment).
I hereby assign all rights to the film, digital media, photography, sound recording and printed quotes thereof made of me during my participation in the Sea Spirit daily program by representatives of Sea Spirit SSD ARL, or their designee. I hereby authorize the reproduction, copyright, exhibition, and/or distribution of said materials worldwide without limitation for any purpose. Sea Spirit SSD ARL, or their designee, may use above mentioned materials for purposes of advertising, publicity and sales promotion. No money shall be due me for such use, now or in the future
LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT
I understand and agree that PADI Members ("Members"), including Sea Spirit Diving Resort and/or any individual PADI Instructors and Divemasters associated with the program in which I am participating, are licensed to use various PADI Trademarks and to conduct PADI training, but are not agents, employees or franchisees of PADI EMEA Ltd., PADI Americas, Inc., or its parent, subsidiary and affiliated corporations ("PADI"). I further understand that Member business activities are independent, and are neither owned nor operated by PADI, and that while PADI establishes the standards for PADI diver training programs, it is not responsible for, nor does it have the right to control, the operation of the Members' business activities and the day-to-day conduct of PADI programs and supervision of divers by the Members or their associated staff.
STATEMENT OF RISK AND LIABILITY
This is a statement in which you are informed of the risks of skin and scuba diving. The statement also sets out the circumstances in which you participate in the diving programme at your own risk. Your signature on this statement is required as proof that you have received and read this statement. It is important that you read the contents of this statement before signing it. If you do not understand anything contained in this statement, then please discuss it with your instructor. If you are a minor, this form must also be signed by a parent or guardian.
WARNING Skin and scuba diving have inherent risks which may result in serious injury or death.
Diving with compressed air involves certain inherent risks; decompression sickness, embolism or other hyperbaric injury can occur that require treatment in a recompression chamber. Open water diving trips that are necessary for training and for certification, may be conducted at a site that is remote, either by time or distance or both, from such a recompression chamber. Skin and scuba diving are physically strenuous activities and you will be exerting yourself during this diving programme. You must advise truthfully and fully inform the dive professionals and the facility through which this programme is offered of your medical history.
ACCEPTANCE OF RISK
I understand and agree that neither the dive professionals conducting this programme, Staff of Sea Spirit Diving Resort, nor the facility through which this programme is conducted, Sea Spirit Diving Resort, nor PADI EMEA Ltd., nor PADI Americas, Inc. nor their affiliate or subsidiary corporations, nor any of their respective employees, officers, agents, contractors or assigns accept any responsibility for any death, injury or other loss suffered by me to the extent that it result from my own conduct or any matter or condition under my control that amounts to my own contributory negligence. In the absence of any negligence or other breach of duty by the dive professionals conducting this programme, Staff of Sea Spirit Diving Resort the facility through which this programme is offered, Sea Spirit Diving Resort, PADI EMEA Ltd., PADI Americas, Inc. and all parties referred to above, my participation in this diving programme is entirely at my own risk.
I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS NON-AGENCY DISCLOSURE AND ACKNOWLEDGMENT AGREEMENT AND STATEMENT OF RISK AND LIABILITY BY READING BOTH BEFORE SIGNING THESE STATEMENTS.
Please read carefully before signing.
This is a statement in which you are informed of some potential risks involved in scuba diving and of the conduct required of you during the scuba training program. Your signature on this statement is required for you to participate in the scuba training program. Read this statement prior to signing it. You must complete this Medical Statement, which includes the medical questionnaire section, to enroll in the scuba training program. In addition, if your medical condition changes at any time during your scuba programs it is important that you inform your instructor immediately. If you are a minor, you must have this Statement signed by a parent or guardian. Diving is an exciting and demanding activity. When performed correctly, applying correct techniques, it is relatively safe. When established safety procedures are not followed, however, there are increased risks. To scuba dive safely, you should 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 coronary disease, a current cold or congestion, epilepsy, a severe medical problem or who is under the influence of alcohol or drugs should not dive. If you have asthma, heart disease, other chronic medical conditions or you are taking medications on a regular basis, you should consult your doctor and the instructor before participating in this program, and on a regular basis thereafter upon completion. You will also learn from the instructor the important safety rules regarding breathing and equalization while scuba diving. Improper use of scuba equipment can result in serious injury. You must be thoroughly instructed in its use under direct supervision of a qualified instructor to use it safely. If you have any additional questions regarding this Medical Statement or the Medical Questionnaire section, review them with your instructor before signing.
4.1 Diver’s Medical Questionnaire
To the Participant:
Recreational scuba diving and freediving requires good physical and mental health. There are a few medical conditions which can be hazardous while diving, listed below. Those who have, or are predisposed to, any of these conditions, should be evaluated by a physician. This Diver Medical Participant Questionnaire provides a basis to determine if you should seek out that evaluation. If you have any concerns about your diving fitness not represented on this form, consult with your physician before diving. If you are feeling ill, avoid diving. If you think you may have a contagious disease, protect yourself and others by not participating in dive training and/
or dive activities. References to “diving” on this form encompass both recreational scuba diving and freediving. This form is principally designed as an initial medical screen for new divers, but is also appropriate for divers taking continuing education. For your safety, and that of others who may dive with you, answer all questions honestly.
Directions
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
| 1. |
I have had problems with my lungs, breathing, heart and/or blood affecting my normal physical or mental performance
|
|
| 2. |
I am over 45 years of age.
|
|
| 3. |
I struggle to perform moderate exercise (for example, walk 1.6 kilometer/one mile in 14 minutes or swim 200 meters/yards without resting), OR I have been unable to participate in a normal physical activity due to fitness or health reasons within the past 12 months.
|
|
| 4. |
I have had problems with my eyes, ears, or nasal passages/sinuses.
|
|
| 5. |
I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery
|
|
| 6. |
I have lost consciousness, had migraine headaches, seizures, stroke, significant head injury, or suffer from persistent neurologic injury or disease
|
|
| 7. |
I am currently undergoing treatment (or have required treatment within the last five years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning or developmental disability
|
|
| 8. |
I have had back problems, hernia, ulcers, or diabetes
|
|
| 9. |
I have had stomach or intestine problems, including recent diarrhea
|
|
| 10. |
I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefloquine (Lariam)
|
|
If you answered NO to all 10 questions above, a medical evaluation is not required. Please read and agree to the participant statement below by signing and dating it.
Participant Statement: I have answered all questions honestly, and understand that I accept responsibility for any consequences resulting from any questions I may have answered inaccurately or for my failure to disclose any existing or past health conditions.
4.2 Standard Safe Diving Practices Statement of Understanding
This is a statement in which you are informed of the established safe diving practices for skin and scuba diving. These practices have been compiled for your review and acknowledgement and are intended to increase your comfort and safety in diving. Your signature on this statement is required as proof that you are aware of these safe diving practices. Read and discuss the statement prior to signing it. If you are a minor, this form must also be signed by a parent or guardian. I understand that as a diver I should:
1. Maintain good mental and physical fitness for diving. Avoid being under the influence of alcohol or dangerous drugs when diving. Keep proficient in diving skills, striving to increase them through continuing education and reviewing them in controlled conditions after a period of diving inactivity, and refer to my course materials to stay current and refresh myself on important information.
2. Be familiar with my dive sites. If not, obtain a formal diving orientation from a knowledgeable, local source. If diving conditions are worse than those in which I am experienced, postpone diving or select an alternate site with better conditions. Engage only in diving activities consistent with my training and experience. Do not engage in cave or technical diving unless specifically trained to do so.
3. Use complete, well-maintained, reliable equipment with which I am familiar; and inspect it for correct fit and function prior to each dive. Have a buoyancy control device, low-pressure buoyancy control inflation system, submersible pressure gauge and alternate air source and dive planning/monitoring device (dive computer, RDP/dive tables—whichever you are trained to use) when scuba diving. Deny use of my equipment to uncertified divers.
4. Listen carefully to dive briefings and directions and respect the advice of those supervising my diving activities. Recognize that additional training is recommended for participation in specialty diving activities, in other geographic areas and after periods of inactivity that exceed six months.
5. Adhere to the buddy system throughout every dive. Plan dives – including communications, procedures for reuniting in case of separation and emergency procedures – with my buddy.
6. Be proficient in dive planning (dive computer or dive table use). Make all dives no decompression dives and allow a margin of safety. Have a means to monitor depth and time underwater. Limit maximum depth to my level of training and experience. Ascend at a rate of not more than 18 metres/60 feet per minute. Be a SAFE diver – Slowly Ascend From Every dive. Make a safety stop as an added precaution, usually at 5 metres/15 feet for three minutes or longer.
7. Maintain proper buoyancy. Adjust weighting at the surface for neutral buoyancy with no air in my buoyancy control device. Maintain neutral buoyancy while underwater. Be buoyant for surface swimming and resting. Have weights clear for easy removal, and establish buoyancy when in distress while diving. Carry at least one surface signaling device (such as signal tube, whistle, mirror).
8. Breathe properly for diving. Never breath-hold or skip-breathe when breathing compressed air, and avoid excessive hyperventilation when breath-hold diving. Avoid overexertion while in and underwater and dive within my limitations.
9. Use a boat, float or other surface support station, whenever feasible.
10. Know and obey local dive laws and regulations, including fish and game and dive flag laws.I have read the above statements and have had any questions answered to my satisfaction.
10. I understand the importance and purposes of these established practices. I recognize they are for my own safety and well-being, and that failure to adhere to them can place me in jeopardy when diving.
