MEMBER APPLICATION/PARTICIPANT INFORMATION

SEA DRAGONS DIVING GROUP INC.

WE KNOW FORMS ARE BORING BUT WE NEED THIS IF YOU ARE DIVING WITH US OR ATTENDING EVENTS

Name

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Post Code

E-mail*

Home Phone

Area CodePhone Number

Mobile Phone

Area CodePhone Number

Emergency Contact/Guardians Name (if under 18)

First NameLast Name

Emergency/ Guardian Contact

Area CodePhone Number

Emergency/ guardian ContactContact

Area CodePhone Number

DIVE QUALIFICATIONS (DIVING MEMBERS ONLY)

How many Dives Completed, when did you last dive (DIVING MEMBERS ONLY)

How did you hear about us?

What type of diving or other activities interest you.

What are you non-diving interests?

MEDICAL STATEMENT

A medical statement must be completed by any person participating in an activity whether seeking to be a dive member or not.

Have you suffered at any time from diseases of the heart and circulation including high blood pressure, angina, chest pains and palpitations?
Have you at any time had chest or heart surgery?
Have you suffered from or had to take medication for asthma?
Have you ever had collapsed lung or pneumothorax?
Have you ever had any other chest or lung disease?
Have you suffered at any time from blackouts, fainting or recurrent dizziness?
Have you had regular ear problems in the past ten years?
Do you have an ileostomy, colostomy or ever had repair of a hiatus hernia?
Have you ever had epilepsy or fits?
Have you had recurrent migraines?
Have you ever had any other disease of the brain or nervous system (including strokes or multiple sclerosis)?
Have you ever had any back or spinal surgery?
Have you any history of mental or psychological illness of any kind, fear of small spaces, crowds or panic attacks?
Have you any history of alcohol or drug abuse in the past five years?
Do you have diabetes?
Are you currently taking any prescribed medication (except the contraceptive pill)?
Are you currently receiving medical care or have you consulted the doctor in the last year other than for trivial infection or minor injury?
Have you ever been refused a diving medical certificate or life insurance or been offered special terms?
Have you ever had, or been treated for, decompression illness?
have you ever been involved in any serious diving –related medical incident, including being present at a dive which suffered a fatality?

Did you have any of the condition listed above or other allergies, chronic illness, or medical conditions that would limit high level activity?*

YesNo

IF YOU ANSWERED "YES", What are the details of the condition or incident?

RISK WARNING

Diving involves risks and dangers, including malfunctions of equipment, risks due to the environment, animal or sea life, risks due to currents and other changing conditions, all of which can result in injuries, including drowning and death.
Diving is a physically strenuous activity, and you will be exerting yourself with a risk of injuries which may include trips and falls, muscle injury and heart attack.
Recreational diving can be carried out in a cold, dark and unfamiliar environment where you may be under more than usual mental stress. You should never dive in conditions that you do not feel comfortable with, or exceed your physical abilities.
Many factors such as ill health, poor fitness, age, drug and alcohol use and inexperience can increase the risk of injury.
Non-diving activities such as driving, camping and other social activities may also include certain risks and dangers that may result in injuries including cuts, burns, trip and fall injuries, collisions, contact with allergens and contaminants and other injuries including death.

There are many ways to reduce these risks to yourself and others including,

Tell people about any issues or concerns.
Have appropriate and well-maintained equipment that you know how to use.
Update and improve your skills.
Plan the dive and dive the plan.
Participate in briefings and buddy checks.
Keep in close contact with your buddy.
Be alert but also be calm. Take a deep breath and think through any problems that occur.
Breath normally and avoid uncontrolled ascents.
Dive within the decompression limits, do safety stops and also leave a safety margin.
Monitor air supply and end the dive with a reserve air supply of at least 500 psi (50 bar).
End the dive early if necessary.
Act responsibly and be mindful of the safety of yourself and others.

You understand that even if you follow all of the appropriate dive practices, there is still some risk of illness, injury or death, and that dive trips may be conducted at locations remote from medical attention, and that your fellow divers are not trained medical personnel.

By signing this form and seeking membership, you declare that;

To the best of yourknowledge, you are in good general health and you have not omitted any information which might be relevant to your fitness for diving. You will not dive when unfit.

You accept that this group is an association of volunteers and you agree to behave responsibly and safely. Further, you hold harmless the Seadragons and their volunteers, agents and representatives from any claim or action for personal injury, property damage or wrongful death however caused, including, but not limited to, negligence.

You agree to abide by the Seadragon's rules, particularly the safety rules and will follow the directions of officials.

You promise to use safe diving practices and to care for the wellbeing of your buddy and other group members.

PARENT/GUARDIAN CONSENT(if under 18)

I give the above undertakings and understand the risks of diving to the person under my care.
I agree to the person under my care participating in all activities.
I realize that, unless explicitly agreed otherwise by authorized Seadragons officers (such as while diving underwater), I am solely responsible for the person under my care while they are participating in Seadragons activities.

I have read the risk warning and agree to the above conditions (please note, membership cannot be approved if you answer "No")*

YesNo

Confirmation E-mail (NB: a confirmation email does not mean membership is approved)*

Electronic Signature (or print, sign, scan and email form). Parent or guardians must also sign if under 18*

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at marinelifetassie@gmail.com. The coffice bearers will notify your when membership is apporved. We will require correct subscriptions and further proof of membership or medical fitness if requested)

SUBCRIPTIONS

Diving Membership - $24.00 p.a. or $2 per month. Pro rata/ Concession/Child - $18 or $1.50 pro rata

Non-Diving Affiliate - free

Intro Membership (max two dives) - Free

BANKING - You will be contacted with details.

THANKS FOR YOUR TIME