Discover Scuba Diving Participant Information

Hawaii Nautical & Port Waikiki Cruises   808-234-7245

www.hawaiinautical.com    or    www.portwaikikicruises.com

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Age 10-17, parent must sign for child. Ages 9 and under too young for diving.
Are you fluent in English? *
Are you flying out within 12 hours of dive? *

Medical Questionnaire

This is a copy of information your dive guide will go over with you, and which you will be required to sign aboard, in the presence of your instructor, on the day of your actual excursion. We ask you to please also go over these health questions and answer them online in advance of your trip in case any of the conditions apply to you, so that you may have more time in which to get a Physician's clearance in advance if required.

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 with a YES or NO. If you are not sure, answer YES.

If any of these items apply to you (if you answer YES on any and still wish to dive), we must request that you consult with a physician prior to participating in scuba diving. Click here to download the PADI Medical Statement and Guidelines for Recreational Scuba Diver’s Physical Examination http://www.padi.com/english/common/courses/forms/pdf/10063-ver2-0.pdf Take that form to a physician, and provide to us no later than the day prior to your scheduled dive. You may email the signed form, or fax it to 808-682-7248. If you answer NO to all of the below medical questions, you do not need the Physical Examination form.

Do you currently have an ear infection? *
Do you have a history of ear disease, hearing loss or problems with balance? *
Do you have a history of ear or sinus surgery? *
Are you currently 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)? *
If any of these items apply to you (if you answer YES on any and still wish to dive), we must request that you consult with a physician prior to participating in scuba diving. Click here to download the PADI Medical Statement and Guidelines for Recreational Scuba Diver’s Physical Examination http://www.padi.com/english/common/courses/forms/pdf/10063-ver2-0.pdf Take that form to a physician, and provide to us no later than the day prior to your scheduled dive. You may email the signed form, or fax it to 808-682-7248. If you answer NO to all of the below medical questions, you do not need the Physical Examination form.

Discover Scuba Diving Safe Diving Practices

This is a copy of information your dive guide will go over with you, and which you will be required to sign aboard, in the presence of your instructor, on the day of your actual excursion (or, if under 18, have  parent or guardian sign on your behalf.)

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 a certified professional guiding me.

To equalize 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 Center, Resort and Instructor to become certified to dive without a professional guide.

Liability Release and Assumption of Risk Agreement

I (participant name to be filled in on the on-board form), hereby affirm that I am aware that skin and scuba diving have inherent risks which may result in serious injury or death.

I affirm I have read and understand the Safe Diving Practices and have had any questions answered to my satisfaction. 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.

I understand that diving with compressed air involves certain inherent risks; decompression sickness, embolism or other hyperbaric injury can occur that requires treatment in a recompression chamber. I further understand that this program may be conducted at a site that is remote, either by time or distance or both, from such a recompression chamber. I still choose to proceed with this program in spite of the absence of a recompression chamber in proximity to the dive site.

The information I have provided about my medical history on the Medical Questionnaire is accurate to the best of my knowledge. I agree to accept responsibility for omissions regarding my failure to disclose any existing or past health conditions.

I understand and agree that neither the dive professionals conducting this program nor the facility through which this activity is conducted, nor International PADI, Inc., nor any of their respective employees, officers, agents or assigns (hereinafter referred to as “Released Parties”) may be held liable or responsible in any way for any injury, death or other damages to me, my family, estate, heirs or assigns that may occur as a result of my participation in this program or as a result of the negligence of any party, including the Released Parties, whether passive or active.

In consideration of being allowed to participate in this program, I hereby personally assume all risks for any harm, injury or damage, whether foreseen or unforeseen, that may befall me while participating in this program, including but not limited to the academics, confined water and/or open water activities.

I further release and hold harmless the Discover Scuba Diving program and the Released Parties from any claim or lawsuit by me, my family, estate, heirs or assigns, arising out of my participation in this program.

I further understand that skin diving and scuba diving are physically strenuous activities and that I will be exerting myself during this program and that if I am injured as a result of heart attack, panic, hyperventilation, etc. that I expressly assume the risk of said injuries and that I will not hold the Released Parties responsible for the same.

I further state that I am of lawful age and legally competent to sign this Assumption of Risk and Liability Release Agreement, or that I have acquired the written consent of my parent or guardian.

I understand that the terms herein are contractual and not a mere recital and that I have signed this Release of my own free act and with the knowledge that I hereby agree to waive my legal rights. I further agree that if any provision of this Agreement is found to be unenforceable or invalid, that provision shall be severed from this Agreement. The remainder of this Agreement will then be construed as though the unenforceable provision had never been contained herein. I (participant name to be filled in aboard in presence of instructor), BY THIS INSTRUMENT DO EXEMPT AND RELEASE THE DIVE PROFESSIONALS CONDUCTING THIS ACTIVITY, THE FACILITY THROUGH WHICH THIS ACTIVITY IS CONDUCTED, AND INTERNATIONAL PADI, INC., AND ALL RELATED ENTITIES AND RELEASED PARTIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH, HOWEVER CAUSED, INCLUDING BUT NOT LIMITED TO THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT BY READING IT BEFORE SIGNING IT ON BEHALF OF MYSELF AND MY HEIRS.

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(Participant Signature and date to be provided aboard)

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(Parent/Guardian Signature, where applicable for those ages 10-17, and date to be provided aboard. Children under 10 may not participate.)