★★ Dive village PADI五星級潛水渡假中心★★ 08-8898528；firstname.lastname@example.org
因教練人力需要安排，預訂報名參加活動及潛水課程之前，請詳細確認下列健康聲明文件內容沒有問題後直接至潛莊ＦＢ粉絲團或LINE ID "dvdiving" 直接來電報名(08)8898528。
Read the following paragraphs carefully. This statement informs you of some potential risks involved in scuba diving and of the conduct required of you during the Discover Scuba Diving program. Your signature is required to participate in the program. If you are a minor, you must have the Participant Statement signed by your parent or guardian. You will also need to learn from the instructor the most important safety rules regarding breathing and equalization while scuba diving. Improper use of scuba equipment can result in serious injury or death. You must be thoroughly instructed in its use under the direct supervision of a qualified instructor to use it safely.
I hereby affirm that I am aware that skin and scuba diving have inherent risks that may result in serious injury or death.
I understand that diving with compressed air involves certain inherent risks; decompression sickness, embolism or other hyperbaric injuries can occur that require treatment in a recompression chamber. I further understand that the open water diving trips which are necessary to participate in 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 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), nor Dive Village Diving Resort, nor any of its 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 scuba diving or as a result of the negligence of any party, including the Released Parties, whether passive or active.
I further release, exempt and hold harmless said Released Parties from any claim or lawsuit by me, my family, estate, heirs, or assigns, arising out of my enrollment and participation in scuba diving including both claims arising during these activities or after I receive my certification.
I also understand that skin 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 a 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 document of my own free act and with the knowledge that I hereby agree to waive my legal rights.
DISCOVER SCUBA DIVING MEDICAL QUESTIONNAIRE
The purpose of this medical questionnaire is to find out if you should be examined by a doctor 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 check the following questions about your past and present medical history. If any of these items apply to you, we must request that you consult with a physician prior to participating in scuba diving.
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 hay fever 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)?