Read this statement prior to signing it. You must complete this in addition to the divers medical questionaire to participate in a diver training program or to participate in any diving activity. If you are a minor you must have this statment signed by your partent or guardian.
Please answer "yes" or "no". If you are not sure, answer "yes". Any "yes" response means that there may be a condition that could affect your safety or the safety of those around you while diving.