• PADI STUDENT RECORD FILE

    Diver Medical | Participant Questionnaire v.0823
  • Student Profile

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  • Emergency Contact Information

    Someone you are not diving with
  • 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 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.

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  • Non-Agency Disclosure and Acknowledgment Agreement

  • I understand and agree that PADI Members (“Members”), including 2536267 Ontario Inc dba Scuba2000 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 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. I further understand and agree on behalf of myself, my heirs and my estate that in the event of an injury or death during this activity, neither I nor my estate shall seek to hold PADI liable for the actions, inactions or negligence of 2536267 Ontario Inc dba Scuba2000 and/or the Instructors and Divemasters associated with the activity.

    I HAVE FULLY INFORMED MYSELF AND MY HEIRS OF THE CONTENTS
    OF THIS NON-AGENCY DISCLOSURE AND ACKNOWLEDGMENT AGREEMENT BY READING IT BEFORE I SIGNED IT ON BEHALF OF MYSELF AND MY HEIRS.

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  • Liability Release and Assumption of Risk Agreement

    Please read carefully and fill the blanks before signing.
  • I hereby affirm that I am aware that skin and scuba diving have inherent risks which may result in serious injury or death. I understand that diving with compressed air involves certain inherent risks; including but not limited to decompression sickness, embolism or other hyperbaric/air expansion injury that require treatment in a recompression chamber. I further understand that the open water diving trips which 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. I still choose to proceed with such instructional dives in spite of the possible absence of a recompression chamber in proximity to the dive site. I understand and agree that neither my instructor(s), 2536267 Ontario Inc dba Scuba2000 Staff, the facility through which I receive my instruction, 2536267 Ontario Inc dba Scuba2000, nor PADI Americas, Inc., nor its affiliate and subsidiary corporations, nor any of their respective employees, officers, agents, contractors 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 diving 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 course (and optional Adventure Dive), hereinafter referred to as “program,” I hereby personally assume all risks of this program, whether foreseen or unforeseen, that may befall me while I am a participant in this program including, but not limited to, the academics, confined water and/or open water activities. I further release, exempt and hold harmless said program and Released Parties from any claim or lawsuit by me, my family, estate, heirs or assigns, arising out of my enrollment and participation in this program including both claims arising during the program or after I receive my certification. I also 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, drowning or any other cause, 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 liability release, or that I have acquired the written consent of my parent or guardian. I understand the terms herein are contractual and not a mere recital, and that I have signed this Agreement 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 understand and agree that I am not only giving up my right to sue the Released Parties but also any rights my heirs, assigns, or beneficiaries may have to sue the Released Parties resulting from my death. I further represent I have the authority to do so and that my heirs, assigns, or beneficiaries will be stopped from claiming otherwise because of my representations to the Released Parties.


    I BY THIS INSTRUMENT AGREE TO EXEMPT AND RELEASE MY INSTRUCTORS, SCUBA 2000's Staff, THE FACILITY THROUGH WHICH I RECEIVE MY INSTRUCTION, 2536267 Ontario Inc dba Scuba2000, AND PADI AMERICAS, INC., AND ALL RELATED ENTITIES 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 AND MY HEIRS OF THE CONTENTS OF THIS NON-AGENCY DISCLOSURE AND ACKNOWLDGEMENT AGREEMENT AND LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT BY READING BOTH BEFORE SIGNING BELOW ON BEHALF OF MYSELF AND MY HEIRS

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  • Privacy Policy

  • In accordance with current legislation, Scuba 2000 has prepared the following Privacy Policy: All personal information collected by Scuba 2000 for the purposes of carrying out its role in scuba diver training or as a supplier of scuba equipment or services will be treated with the utmost care and will be used ONLY in the execution of that agreed upon role. No information will be shared with any other party without the express written agreement of the customer other than to facilitate the completion of the agreed upon services of Scuba 2000 to the customer. It is hereby agreed that Scuba 2000 may use the personal information submitted to occasionally send the customer pertinent and useful information via telephone, mail, email or through any form of communication given at the time of filling in this sheet. This information will be related to the role of Scuba 2000 as a Dive Center and Supplier. To Unsubscribe or to learn more about our privacy policy, please visit https://www.scuba2000.com/privacypolicy/ Any questions or requests may be sent
    by email at dive@scuba2000.com , by telephone at 905-771-1500 or regular mail at Scuba 2000, 9033 Leslie Street, Richmond Hill, Ontario L4B 4K3.

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  • Diver Medical | Participant Questionnaire

    Recreational scuba diving and freediving requires good physical and mental health. There are a few medical conditions which cancbe hazardous while diving, listed below. Those who have, or are predisposed to, any of these conditions, should be evaluated by a physician. This Diver Medical Participant Questionnaire provides a basis to determine if you should seek out that evaluation. If you have any concerns about your diving fitness not represented on this form, consult with your physician before diving. If you are feeling ill, avoid diving. If you think you may have a contagious disease, protect yourself and others by not participating in dive training and/or dive activities. References to “diving” on this form encompass both recreational scuba diving and freediving. This form is principally designed as an initial medical screen for new divers, but is also appropriate for divers taking continuing education. For your safety, and that of others who may dive with you, answer all questions honestly.
  • Directions

    Complete this questionnaire as a prerequisite to a recreational scuba diving or freediving course.Note to women: If you are pregnant, or attempting to become pregnant, do not dive.
  • Participant Signature

    If you answered NO to all 10 questions above, a medical evaluation is not required. Please read and agree to the participant statementbelow by signing and dating it.
  • Participant Statement:

    I have answered all questions honestly, and understand that I accept responsibility for any consequencesresulting from any questions I may have answered inaccurately or for my failure to disclose any existing or past health conditions.
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