Achilleon Diving Center

Paperwork for preparing your stay

To prepare your stay,
you have these documents to fill out and submit:

All forms are mandatory

Registration Form

Diver Medical | Participant Questionnaire

Diver Medical | Participant Questionnaire

Recreational scuba diving and freediving requires good physical and mental health. There are a few medical conditions which can be 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.

INSTRUCTIONS
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.

1. I have had problems with my lungs, breathing, heart and/or blood affecting my normal physical or mental performance.

2. I am over 45 years of age.

3. I struggle to perform moderate exercise (for example, walk 1.6 kilometer/one mile in 14 minutes or swim 200 meters/yards without resting), OR I have been unable to participate in a normal physical activity due to f􀁁ness or health reasons within the past 12 months.

4. I have had problems with my eyes, ears, or nasal passages/sinuses.

5. I have had surgery within the lost 12 months. OR I have ongoing problems related to past surgery.

6. I have lost consciousness. hod migraine headaches. seizures, stroke, significant head injury, or suffer from persistent neurologic injury or disease.

7. I am currently undergoing treatment (or have required treatment within the last five years) for psychological problems. personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I hove been diagnosed with a learning or developmental disability.

8. I have had back problems. hernia, ulcers, or diabetes.

9. I have had stomach or intestine problems, including recent diarrhea.

10. I am taking prescription medications (with the exception of birth control or or anti-malarial drugs other than mefloquine (Loriom).

Participant Signature

If you answered NO to all 10 questions above, a medical evaluation is not required. Please read and agree to the participant statement below by signing and dating it.

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

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If you answered YES to questions 3, 5 or 10 above OR to any of the questions on page 2, please read and agree to the statement above by signing and dating it AND take all three pages of this form (Participant Questionnaire and the Physician's Evaluation Form) to your physician for a medical evaluation. Participation in a diving course requires your physician's approval.

Diver Medical | Participant Questionnaire Continued

BOX A-I HAVE/HAVE HAD:

Chest surgery, heart surgery, heart valve surgery, an implantable medical device (eg, stent, pacemaker. neurostimulator), pneumothorax, and/or chronic lung disease.

Asthma. wheezing, severe ollergies, hoy fever or congested airways within the last 12 months that limits my physicol octivity/exercise.

A problem or illness involving my heart such as: angina, chest pain on exertion, heart foilure, immersion pulmonary edema, heort attock or stroke, OR am taking medication for any heart condition.

Recurrent bronchitis and currently coughing within the past 12 months, OR have been diagnosed with emphysema.

Symptoms affecting my lungs, breathing, heart and/or blood in the last 30 days that impair my physical or mental performance.


BOX B - I AM OVER 45 YEARS OF AGE AND:

I currently smoke or inhale nicotine by other means.

I have a high cholesterol level.

I have high blood pressure.

I have hod a close blood relative die suddenly or of cordiac disease or stroke before the age of 50, OR hove a family history of heort disease before age 50 (including abnormal heart rhythms, coronary artery disease or cardiomyopathy).


BOX C - I HAVE/HAVE HAD:

Sinus surgery within the last 6 months.

Ear disease or eor surgery, hearing loss, or problems with balance

Recurrent sinusitis within the past 12 months.

Eye surgery within the past 3 months


BOX D - I HAVE/HAVE HAD:

Head injury with loss of consciousness within the post 5 years.

Persistent neurologic injury or disease.

Recurring migraine headaches within the past 12 months. or take medications to prevent them.

Blockouts or fainting (full/parti:il loss of consciousness) within the last 5 years.

Epilepsy, seizures, or convulsions. OR take medications to prevent them.


BOX E - I HAVE/HAVE HAD:

Behavioral health, mental or psychologicol problems requiring medical/psychiatric treatment.

Major depression, suicidal ideation, panic attacks, uncontrolled bipolar disorder requiring medication/psychiatric tre:itment

Been diagnosed with a mental health condition or ::. learning/developmental disorder that requires ongoing care or special accommodation.

An oddiction to drugs or alcohol requiring treatment within the lost 5 years.


BOX F - I HAVE/HAVE HAD:

Recurrent back problems in the last 6 months that limit my everydoy activity

Back or spinal surgery within the last 12 months.

Diabetes, either drug or diet controlled, OR gestational diabetes within the last 12 months.

An uncorrected hernia that limits my physical abilities.

Active or untreated ulcers, problem wounds, or ulcer surgery within the last 6 months


BOX G - I HAVE HAD:

Ostomy surgery and do not have medical clearance to swim or engage in physical activity.

Dehydration requiring medical intervention within the last 7 days.

Active or untreated stomach or intestinal ulcers or ulcer surgery within the last 6 months.

Frequent heartburn, regurgitation, or gastroesophageal reflux disease (GERO).

Active or uncontrolled ulcerative colitis or Crohn's disease.

Bariatric surgery within the last 12 months.

Standard Safe Diving Practices Statement of Understanding

PADI padi.com

ΣΥΝΗΘΕΙΣ ΠΡΑΚΤΙΚΕΣ ΑΣΦΑΛΟΥΣ ΚΑΤΑΔΥΣΗΣ

ΔΗΛΩΣΗ ΚΑΤΑΝΟΗΣΗΣ

Παρακαλώ διαβάστε προσεκτικά και συμπληρώστε όλα τα κενά πριν υπογράψετε.

Αυτή είναι μια δήλωση μέσω της οποίας πληροφορείστε σχετικά με τις καθιερωμένες πρακτικές ασφαλούς κατάδυσης στην ελεύθερη και αυτόνομη κατάδυση. Αυτές οι πρακτικές έχουν συγκεντρωθεί εδώ ώστε να μπορέσετε να τους κάνετε μια ανασκόπηση και σας γνωστοποι- ούνται με σκοπό την αύξηση της άνεσης και της ασφάλειάς σας στην κατάδυση. Η υπογραφή σας σε αυτή την δήλωση είναι απαραίτητη, ως απόδειξη ότι έχετε λάβει υπόψη σας αυτές τις πρακτικές ασφαλούς κατάδυσης. Διαβάστε και συζητήστε τη δήλωση πριν την υπογρά- ψετε. Εάν είστε ανήλικος, αυτή η φόρμα πρέπει επίσης να υπογραφεί από κάποιο γονέα ή κηδεμόνα.

Εγώ ο/η,

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STATEMENT OF RISKS AND LIABILITY -SCUBA DIVING TRIPS AND BOAT TRAVEL (PADI International Ltd)

Please read carefully and fill In the following form.

This is a statement in which you are informed of the risks of hazards occurring whilst travelling to and participating in scuba dives either as a certified diver or as a student under the control and supervision of a certified scuba instructor. This statement covers recreational scuba dive trips and scuba dive trips carried out as part of a scuba diving class. This statement also sets out the circumstances in which you participate in the scuba diving trip 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 I dive professional. 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 scuba diving trips may be conducted at a site that is remote, either by time or distance, from such a recompression chamber.
In addition, during boat travel to and from dive sites, you should follow all safety instructions from the captain I crew members and take care while getting on or off the boat and while on board to avoid slipping, falling or drowning.

EXCLUSION OF LIABILITY
I understand and agree that neither (divemasters/crew members/captain) nor the crew or the owner of the vessel, (vessel name) nor PADI International Ltd., nor PADI Americas Inc., nor their affiliate or subsidiary companies, nor any of their respective employees, officers, agents or assigns (hereinafter referred to as "Released Parties") accept any responsibility for any death, Injury or other loss suffered or caused by me or resulting from my own conduct or any matter or condition under my control which amounts to my own contributory negligence, during or as a consequence of my participation in this scuba diving trip.
In the absence of any negligence or breach of duty by the crew or owner of the vessel, PADI lnternatlonal Ltd., PADI Americas, Inc., and all released entitles and released parties as defined above, my participation in this scuba diving trip Is entirely at my own risk.

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