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.
Read this statement prior to signing it. You must complete this additional medical questionnaire to enrol in a diver training program or to participate in any diving activity. If you are a minor, you must have this statement signed by your parent or guardian.
The purpose of this medical questionnaire is to ensure that you are medically fit to dive. Please answer the following questions with a YES or NO. If you are not sure, answer YES. A positive response means that there may be a preexisting condition that could affect your safety while diving. If any of these items apply to you, we must request that you consult with a physician, preferably a specialist in diving medicine, prior to participating in diving activities.
Within the 40 days immediately preceding the date of this Health Declaration Form, have you:
The information I have provided about my medical history is accurate to the best of my knowledge. I agree to accept responsibility for any omissions in disclosing my existing or past health conditions. I also commit to inform Sea Spirit S.S.D. A.R.L about any symptom that may arrive after having filled in this declaration and/or having come into contact with someone who has tested positive after signing the declaration.
I WILL, if asked, wear a protective mask at all times while participating in the diving training / activities arranged by Sea Spirit S.S.D. A R.L, and will take all reasonable preventive steps that may be recommended by Sea Spirit S.S.D. A R.L, or any relevant public authority.*
I WILL accept and observe all instructions by Sea Spirit S.S.D. A R.L intended to abide by all existing regulations, required to help prevent the risk of transmission, including having my temperature taken prior to participating in any diving activities*
I ACKNOWLEDGE and ACCEPT that this declaration will be considered as my consent to Sea Spirit S.S.D. A R.L o retain this declaration and disclose it to any relevant authority or service provider for the purposes of ensuring the safety of any third parties that may come in contact with me prior to, during, and after any diving activity.*
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
Non-Agency Disclosure and Acknowledgment Agreement
I understand and agree that PADI Members ("Members"), including Sea Spirit S.S.D. A R.L. 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, the certified diver, are informed of the risks of skin and scuba diving. The statement also sets out the circumstances in which you participate in the diving experience 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.
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 may be necessary for this experience 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 experience. Past or present medical conditions may be contraindicative to your participation in this experience. You must be in good mental and physical fitness for diving, and not under the influence of alcohol, nor any drugs that are contraindicatory to diving. If you are taking medications, that you have seen a physician and have approval to dive whilst taking these. You need to inspect all of your equipment prior to this experience and notify the dive professionals and the facility through which this experience is offered if any of your equipment is not working properly.
Acceptance of Risk
I understand and agree that neither the dive professionals conducting this program,__________________________, nor the facility through which this program is conducted, Sea Spirit S.S.D. A R.L., 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 program,____________________________, the facility through which this program is offered, Sea Spirit S.S.D. A R.L., PADI EMEA Ltd., PADI Americas, Inc. and all parties referred to above, my participation in this diving program 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.
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