ReActivate/Refresher Course Required Information Required First name Optional Middle Initial Required Last name Required Email Required Gender MaleFemale Required Date of birth (dd/mm/yyyy) Required Address Required City or town Required County Required Post code Fixed Field. Please call 01733 351288 if your address is not in the UK Country UK Required Mobile Phone Required Diving Course ---PADI ReActivate/Refresher Required Diving Course Start Date (the date of the first pool session OR open water session if no pool involved) Required Payment Method. ---Card by PhonePayPalCash at Dive CentreCard at Dive Centre Required Payment Date. Required Payment Amount. Required Height in feet & inches Required UK Chest/Dress Size Required UK Waist Size Required UK Shoe Size Diving Course Participant Statement of Risk and Liability/Non-agency Acknowledgment Form GENERAL TRAINING (EU Version) Please read carefully and fill in all blanks before signing Non-Agency Disclosure and Acknowledgment Agreement I understand and agree that PADI Members ("Members"), including Dive In 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, nor the facility through which this programme is conducted, Dive In, 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, the facility through which this programme is offered, Dive In, 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. STANDARD SAFE DIVING PRACTICES STATEMENT OF UNDERSTANDING Please read carefully before signing. 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. 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. RSTC MEDICAL STATEMENT Participant Record (Confidential Information) 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 offered by Dive In, located in the Facility town of Whittlesey, county of Cambridgeshire, UK. and their Instructors, and Divemasters. 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. 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. Divers Medical Questionnaire To the Participant: The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in recreational diver training. 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 your physician prior to engaging in dive activities. Please answer the following questions on your past or present medical history with a YES or NO. If you are not sure, answer YES. If any of these items apply to you, we must request that you consult with a physician prior to participating in scuba diving. Your instructor will supply you with an RSTC Medical Statement and Guidelines for Recreational Scuba Diver’s Physical Examination to take to your physician. Could you be pregnant, or are you attempting to become pregnant?---NOYES Are you presently taking prescription medications? (with the exception of birth control or anti-malarial) ---NOYES Are you over 45 years of age and can answer YES to one or more of the following? • currently smoke a pipe, cigars or cigarettes • have a high cholesterol level • have a family history of heart attack or stroke • are currently receiving medical care • high blood pressure • diabetes mellitus, even if controlled by diet alone ---NOYES Have you ever had or do you currently have… Asthma, or wheezing with breathing, or wheezing with exercise?---NOYES Frequent or severe attacks of hayfever or allergy?---NOYES Frequent colds, sinusitis or bronchitis?---NOYES Any form of lung disease?---NOYES Pneumothorax (collapsed lung)?---NOYES Other chest disease or chest surgery?---NOYES Behavioral health, mental or psychological problems (Panic attack, fear of closed or open spaces)? ---NOYES Epilepsy, seizures, convulsions or take medications to prevent them?---NOYES Recurring complicated migraine headaches or take medications to prevent them? ---NOYES Blackouts or fainting (full/partial loss of consciousness)?---NOYES Frequent or severe suffering from motion sickness (seasick, carsick, etc.)? ---NOYES Dysentery or dehydration requiring medical intervention?---NOYES Any dive accidents or decompression sickness?---NOYES Inability to perform moderate exercise (example: walk 1.6 km/one mile within 12 mins.)?---NOYES Head injury with loss of consciousness in the past five years?---NOYES Recurrent back problems?---NOYES Back or spinal surgery?---NOYES Diabetes?---NOYES Back, arm or leg problems following surgery, injury or fracture?---NOYES High blood pressure or take medicine to control blood pressure?---NOYES Heart disease?---NOYES Heart attack?---NOYES Angina, heart surgery or blood vessel surgery?---NOYES Sinus surgery?---NOYES Ear disease or surgery, hearing loss or problems with balance?---NOYES Recurrent ear problems?---NOYES Bleeding or other blood disorders?---NOYES Hernia?---NOYES Ulcers or ulcer surgery?---NOYES A colostomy or ileostomy?---NOYES Recreational drug use or treatment for, or alcoholism in the past five years?---NOYES The information I have provided about my medical history 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 condition. Under 18? Your parent or guardian must enter their name and relationship below, and also tick the agreement box for you under Required below Applicable? Name Applicable? Relationship ---FatherMotherGuardian Required I am 18 or older, and I hereby tick the box below as my digital signature and agreement to these statementsI agree After you hit the 'Send' button below You'll receive confirmation that ... "Your diving course required information was sent successfully to email@example.com" and we’ll send you a confirmation email To use CAPTCHA, you need Really Simple CAPTCHA plugin installed.