Fillable Printable Discover Scuba Diving - Australia
Fillable Printable Discover Scuba Diving - Australia
Discover Scuba Diving - Australia
Discover
Scuba
Diving
Discover
Scuba
Diving
English
DIVING IS FUN
...START TODAY......START TODAY...
Product No: 61200 Version 2.0 (01/04)
CERTIFICATE
Certificate of Recognition
Congratulations on completion of your
Discover Scuba Diving
with
PADI PROFESSIONAL Date
Important: This is NOT a Scuba Certification
No.
1. MEDICAL DECLARATION
Have you suffered from, or do you now
suffer from, any of the following:-
Yes No
Asthma or wheezing
Fainting, seizures or blackouts
Chronic Bronchitis or persistent chest complaints
Chronic sinus conditions
Chest surgery
Recurrent ear problems when flying
Epilepsy
Diabetes Mellitus (sugar diabetes)
Tuberculosis or other long-term lung disease
Brain, spinal cord or nervous disorder
Heart disease of any kind
Collapsed lung (pneumothorax)
Ear surgery
Are you currently suffering from:- Yes No
Breathlessness
Chronic Ear Discharge or infection
High Blood Pressure
Perforated eardrum
Other illness or operation within the last month
Are you currently taking any medicine or drug
(excluding oral contraceptives)?
Have you ingested any alcohol within
the last 8 hours prior to diving?
Are you pregnant?
Do you understand that any concealment
of any condition incompatible with safe diving
Yes No
might put your health or life at risk?
Do you understand that you should not go to
altitude (fly) within 12 hours of completing
a single dive or 18 hours when doing
multiple dives (where possible wait 24 hrs)?
2. DISCOVER SCUBA DIVING SAFE DIVING PRACTICES
These practices have been compiled for your review and acknowledgment and are intended to increase your comfort and safety in diving.
I understand that upon completing the Discover Scuba Diving program, I will not be qualified to dive independently without
certified professional guiding me.
To equalise my ears and sinus air spaces, I will need to blow gently against pinched nostrils every few feet/one metre while descending.
If I have discomfort in my ears or sinuses during descent, I should stop my descent and alert my instructor.
Underwater, I should breathe slowly, deeply, continuously and never hold my breath.
I should respect underwater life and not touch, tease or harass an underwater organism since it may harm me and/or I may harm it.
I can seek further training from any PADI Dive Centre, Resort and Instructor to become certified to dive without a professional guide.
No.
No.
PADI ASIA PACIFIC
PO Box 575
Brookvale NSW 2100
AUSTRALIA
Place
Stamp
Here
3. STATEMENT OF UNDERSTANDING AND ASSUMPTION OF RISK AGREEMENT - DISCOVER SCUBA DIVING
(Please read carefully, before signing.)
I, hereby affirm that I am aware and understand the inherent risks of skin diving and scuba diving, and in
particular, I acknowledge:
1 That I have read and understand the Discover Scuba Diving Safe Diving Practices and have had any questions answered to my satisfaction. I
recognise these practices are for my own safety and well being, and that failure to adhere to them can place me in jeopardy when diving.
2 That diving with compressed air involves certain inherent risks of decompression illness, embolism, and other hyperbaric injuries and that such
injuries may result in death or serious disablement.
3 That injuries of the type referred to in Clause 2 above may require treatment in a recompression chamber. That open water diving trips which are
part of the Discover Scuba Diving program may be conducted at a site that is remote either by time and/or distance from a recompression
chamber. I choose to participate in the Discover Scuba Diving program despite the possible absence of a recompression chamber in proximity to
the dive site.
4 That skin diving and scuba diving are physically demanding activities and in susceptible individuals may cause heart attack, panic or
hyperventilation.
5 That scuba diving involves the use of equipment that may malfunction giving rise to risk of death or disablement.
6 That skin diving and scuba diving necessarily involve the exposure to the natural elements including but not limited to storm, tempest, wind, tides
and marine life. Such exposure brings with it attendant risk of death or disablement.
7 That the Discover Scuba Diving program is designed to provide me with a safe introduction to scuba diving. The program is not intended to train
me as a competent diver. I further understand and agree that I must be thoroughly instructed in the use of SCUBA under the direct supervision
of a qualified instructor to become a certified, competent diver.
8 In consideration of being allowed to participate in this Discover Scuba Diving program, I hereby personally assume all risks in connection with the
said program, for any harm, injury or damage that may befall me while I am participating in this Discover Scuba Diving program, including all risks
connected therewith, whether foreseen or unforeseen.
9 The information I have provided about my medical history on the Medical Declaration is accurate to the best of my knowledge and belief. I agree
to accept responsibility for omissions regarding my failure to disclose any existing or past health conditions.
10 I further state that I am of lawful age and legally competent to sign this statement of understanding, or alternatively, the written consent of my
parent or legal guardian is provided herewith.
11 In the event that any part of this document is held to be inconsistent with any relevant statute, then the parties agree that the document will be
invalid to the extent of that inconsistency only.
12 I understand that the terms herein are contractual and not a mere recital, and that I have signed this document of my own free will.
Flying After Diving Recommendations
1) For single dives within the no decompression limits, a minimum pre-flight surface interval of 12 hours is suggested. 2) For repetitive
dives and/or multi-day dives within the no decompression limits, a minimum pre-flight surface interval of 18 hours is suggested.
3) For dives requiring decompression stops, a minimum pre-flight surface interval greater than 18 hours is suggested.
4. LIABILITY RELEASE AND STATEMENT OF INTENTION - DISCOVER SCUBA DIVING
I, the aforementioned, have fully informed myself of the contents of the "Statement of Understanding and Assumption of Risk Agreement" and this
"Liability Release" before signing it on behalf of myself and my heirs. I further agree that neither the dive professional conducting this activity,
, the facility through which this activity is conducted ,
International PADI, Inc., PADI Asia Pacific nor any of their respective employees, officers, agents or assigns (hereinafter referred to as the "Released
Parties") may be held liable or responsible in any way for any injury, death, or other damages to me or my family, heirs or assigns that may occur as
a result of my participation in this Discover Scuba Diving program, whether such injury or damage is foreseen or unforeseen.
I, THE AFOREMENTIONED, BY THIS INSTRUMENT DO EXEMPT AND RELEASE THE RELEASED PARTIES FROM ALL LIABILITY AND RESPONSIBILITY
WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWSOEVER CAUSED, INCLUDING BUT NOT LIMITED TO ANY
NEGLIGENT ACT OR OMISSION OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE.
Participant Signature Parent/Guardian Signature Date
