{"id":375819,"date":"2025-12-02T14:31:28","date_gmt":"2025-12-02T19:31:28","guid":{"rendered":"https:\/\/anklaazul.com\/?page_id=375819"},"modified":"2026-02-23T10:50:34","modified_gmt":"2026-02-23T15:50:34","slug":"liability-waiver","status":"publish","type":"page","link":"https:\/\/anklaazul.com\/es\/liability-waiver\/","title":{"rendered":"Exenci\u00f3n de Responsabilidad"},"content":{"rendered":"<div class=\"et_pb_section_0 et_pb_section et_section_regular et_flex_section\">\n<div class=\"et_pb_row_0 et_pb_row et_flex_row preset--module--divi-row--default\">\n<div class=\"et_pb_column_0 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone et_flex_column_24_24_phoneWide et_flex_column_24_24_tabletWide\">\n<div class=\"et_pb_image_0 et_pb_image et_pb_module et_flex_module preset--module--divi-image--default\"><span class=\"et_pb_image_wrap\"><img decoding=\"async\" src=\"https:\/\/anklaazul.com\/wp-content\/uploads\/2024\/12\/1.png\" width=\"1500\" height=\"1500\" srcset=\"https:\/\/anklaazul.com\/wp-content\/uploads\/2024\/12\/1.png 1500w, https:\/\/anklaazul.com\/wp-content\/uploads\/2024\/12\/1-1280x1280.png 1280w, https:\/\/anklaazul.com\/wp-content\/uploads\/2024\/12\/1-980x980.png 980w, https:\/\/anklaazul.com\/wp-content\/uploads\/2024\/12\/1-480x480.png 480w\" sizes=\"(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) and (max-width: 980px) 980px, (min-width: 981px) and (max-width: 1280px) 1280px, (min-width: 1281px) 1500px, 100vw\" class=\"wp-image-372136\" title=\"Ankla Azul Logo\" alt=\"Ankla Azul Logo\" \/><\/span><\/div>\n\n<div class=\"et_pb_text_0 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module preset--module--divi-text--71ller6c7t\"><div class=\"et_pb_text_inner\"><h1 class=\"et-vb-page-bar-title\" contenteditable=\"true\" style=\"text-align: center;\">Exenci\u00f3n de Responsabilidad<\/h1>\n<\/div><\/div>\n\n<div class=\"et_pb_text_1 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module preset--module--divi-text--efokf8vg5e\"><div class=\"et_pb_text_inner\"><h2 style=\"text-align: center;\">Elige tu idioma<\/h2>\n<\/div><\/div>\n\n<div class=\"et_pb_group_0 et_pb_group et-last-child et_pb_module et_flex_group et_pb_css_mix_blend_mode_passthrough\">\n<div class=\"et_pb_module et_pb_button_module_wrapper et_pb_button_0_wrapper preset--module--divi-button--p90tt5zbku_wrapper\"><a class=\"et_pb_button_0 et_pb_button et_pb_bg_layout_light et_pb_module et_block_module preset--module--divi-button--p90tt5zbku\" href=\"#En\" data-icon=\"9\" data-interaction-trigger=\"3n7x2x6k1t\">Ingl\u00e9s<\/a><\/div>\n\n<div class=\"et_pb_module et_pb_button_module_wrapper et_pb_button_1_wrapper preset--module--divi-button--p90tt5zbku_wrapper\"><a class=\"et_pb_button_1 et_pb_button et_pb_bg_layout_light et_pb_module et_block_module preset--module--divi-button--p90tt5zbku\" href=\"#Sp\" data-icon=\"9\" data-interaction-trigger=\"twg2v6seqn\">Espa\u00f1ol<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_section_1 et_pb_section et_section_regular et_flex_section et-interaction-target-x9y6pu0g6j preset--module--divi-section--n39wc5psvj\" data-interaction-target=\"x9y6pu0g6j\" id=\"En\">\n<div class=\"et_pb_row_1 et_pb_row et_flex_row preset--module--divi-row--oq2ebt1ewh\">\n<div class=\"et_pb_column_1 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone et_flex_column_24_24_phoneWide et_flex_column_24_24_tabletWide\">\n<div class=\"et_pb_icon_0 et_pb_icon et_pb_module et_flex_module preset--module--divi-icon--4sr05b39e7\" data-interaction-trigger=\"4rnjuw860s\"><span class=\"et_pb_icon_wrap\"><span class=\"et-pb-icon\">\uf00d<\/span><\/span>\n<div class=\"et_pb_text_2 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module preset--module--divi-text--3tx68shv89\" data-interaction-trigger=\"17yftbr1rf\"><div class=\"et_pb_text_inner\"><p>Cerrar Formulario<\/p>\n<\/div><\/div>\n<\/div>\n\n<div class=\"et_pb_text_3 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module preset--module--divi-text--icujiwwkuf\"><div class=\"et_pb_text_inner\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-372294 forminator-design--bold forminator-enclosed\" data-forminator-render=\"0\" data-form=\"forminator-module-372294\" data-uid=\"6a02103ccdbe6\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-372294\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-372294 forminator-design--bold forminator-enclosed\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"372294\"\r\n\t\t\t\t data-color-option=\"theme\" data-design=\"bold\" data-grid=\"enclosed\" style=\"display: none;\"\r\n\t\t\t\tdata-uid=\"6a02103ccdbe6\" action=\"\"\r\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div role=\"tablist\" class=\"forminator-pagination-steps\" aria-label=\"Pagination\"><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-372294--page-0\"\r\n\t\t\t\tclass=\"forminator-pagination forminator-pagination-start\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-372294--page-0-label\"\r\n\t\t\t\tdata-step=\"0\"\r\n\t\t\t\tdata-label=\"Waivers &amp; Agreements\"\r\n\t\t\t\tdata-actual-label=\"Welcome &amp; Eco-Pledge\"\r\n\t\t\t\tdata-name=\"page-break-5\"\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><label class=\"forminator-label\">Welcome Message<\/label><div style=\"text-align: center;padding: 30px;background-color: #f0fdf4;border: 2px solid #22c55e;border-radius: 10px;margin-bottom: 20px\">\n  <h2 style=\"color: #15803d;margin-top: 0\">Welcome to Ankla Azul<\/h2>\n  <h4 style=\"color: #16a34a;margin-top: 5px;font-weight: bold\">Blue Ocean Diving Center<\/h4>\n  <p style=\"font-size: 1.1em;color: #374151\">We are committed to protecting our marine environment.<\/p>\n  <p>To support conservation efforts and <strong>reduce paper waste<\/strong>, we have transitioned to this 100% digital registration process. By filling this out digitally, you are helping us minimize our ecological footprint.<\/p>\n  <p style=\"font-weight: bold;color: #15803d;margin-top: 15px\">Thank you for helping us keep our oceans clean!<\/p>\n<\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-2\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><label class=\"forminator-label\">Safety Warning<\/label><div style=\"background-color: #f0f9ff;border-left: 5px solid #0ea5e9;padding: 20px;border-radius: 5px;margin-bottom: 20px\">\n  <h3 style=\"margin-top:0;color: #0284c7;font-size: 18px;font-weight: bold\">IMPORTANT: PLEASE READ CAREFULLY<\/h3>\n  <p style=\"margin-bottom: 10px\">Your safety is our top priority.<\/p>\n  <p>Before we begin your underwater adventure, you are required to complete this <strong>Exoneraci\u00f3n de responsabilidad<\/strong> y <strong>Medical Declaration<\/strong>.<\/p>\n  <ul style=\"margin-left: 20px;margin-bottom: 10px\">\n    <li><strong>TRUTHFULNESS IS VITAL:<\/strong> You must answer all questions <strong>truthfully and accurately<\/strong>. Withholding information regarding your medical history can lead to serious injury or death while diving.<\/li>\n    <li><strong>LEGAL DOCUMENT:<\/strong> This is a legally binding contract. You will be required to <strong>sign<\/strong> at the end to confirm that all information provided is true.<\/li>\n  <\/ul>\n  <p style=\"font-style: italic;color: #0284c7\">By filling out this form, you agree to provide honest answers for your own safety.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-372294--page-1\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-372294--page-1-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"1\"\r\n\t\t\t\tdata-label=\"Welcome &amp; Eco-Pledge\"\r\n\t\t\t\tdata-actual-label=\"Participant Details &amp; Logistics\"\r\n\t\t\t\tdata-name=\"page-break-1\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-12\"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-first-name-2_6a02103ccdbe6\" id=\"forminator-field-first-name-2_6a02103ccdbe6-label\" class=\"forminator-label\">Nombre <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2-first-name\" placeholder=\"E.g. John\" id=\"forminator-field-first-name-2_6a02103ccdbe6\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"given-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-last-name-2_6a02103ccdbe6\" id=\"forminator-field-last-name-2_6a02103ccdbe6-label\" class=\"forminator-label\">Apellido <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2-last-name\" placeholder=\"E.g. Doe\" id=\"forminator-field-last-name-2_6a02103ccdbe6\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"family-name\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6\"><label for=\"forminator-field-date-1\" id=\"forminator-field-date-1-label\" class=\"forminator-label\">Fecha de nacimiento <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-date-select\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-1-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-372294__field--date-1-day_6a02103ccdbe6\" id=\"forminator-field-372294__field--date-1-day_6a02103ccdbe6-label\" class=\"forminator-label\">D\u00eda<\/label><select name=\"date-1-day\" id=\"forminator-field-372294__field--date-1-day_6a02103ccdbe6\" class=\"forminator-select2\" data-format=\"dd\/mm\/yy\" data-parent=\"date-1\" aria-describedby=\"forminator-field-date-1_6a02103ccdbe6-description\" aria-labelledby=\"forminator-field-372294__field--date-1-day_6a02103ccdbe6-label\" data-default-value=\"\"><option value=\"\" selected=\"selected\">Seleccionar un d\u00eda<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><\/div><\/div><div id=\"date-1-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-372294__field--date-1-month_6a02103ccdbe6\" id=\"forminator-field-372294__field--date-1-month_6a02103ccdbe6-label\" class=\"forminator-label\">Mes<\/label><select name=\"date-1-month\" id=\"forminator-field-372294__field--date-1-month_6a02103ccdbe6\" class=\"forminator-select2\" data-format=\"dd\/mm\/yy\" data-parent=\"date-1\" aria-describedby=\"forminator-field-date-1_6a02103ccdbe6-description\" aria-labelledby=\"forminator-field-372294__field--date-1-month_6a02103ccdbe6-label\" data-default-value=\"\"><option value=\"\" selected=\"selected\">Seleccionar mes<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><\/div><\/div><div id=\"date-1-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-372294__field--date-1-year_6a02103ccdbe6\" id=\"forminator-field-372294__field--date-1-year_6a02103ccdbe6-label\" class=\"forminator-label\">A\u00f1o<\/label><select name=\"date-1-year\" id=\"forminator-field-372294__field--date-1-year_6a02103ccdbe6\" class=\"forminator-select2\" data-format=\"dd\/mm\/yy\" data-parent=\"date-1\" aria-describedby=\"forminator-field-date-1_6a02103ccdbe6-description\" aria-labelledby=\"forminator-field-372294__field--date-1-year_6a02103ccdbe6-label\" data-default-value=\"\"><option value=\"\" selected=\"selected\">Seleccionar a\u00f1o<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><\/select><\/div><\/div><\/div><\/div><span id=\"forminator-field-date-1_6a02103ccdbe6-description\" class=\"forminator-description\">Ingresa tu fecha de nacimiento<\/span><\/div><div id=\"phone-4\" class=\"forminator-field-phone forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-4_6a02103ccdbe6\" id=\"forminator-field-phone-4_6a02103ccdbe6-label\" class=\"forminator-label\">Tel\u00e9fono <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-phone-4_6a02103ccdbe6-description\" class=\"forminator-description\">Tu Tel\u00e9fono<\/span><input type=\"text\" name=\"phone-4\" value=\"\" placeholder=\"Phone \/ WhatsApp\" id=\"forminator-field-phone-4_6a02103ccdbe6\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" data-national_mode=\"disabled\" data-country=\"co\" data-validation=\"international\" aria-describedby=\"forminator-field-phone-4_6a02103ccdbe6-description\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a02103ccdbe6\" id=\"forminator-field-email-1_6a02103ccdbe6-label\" class=\"forminator-label\">Correo Electr\u00f3nico <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-email-1_6a02103ccdbe6-description\" class=\"forminator-description\">Tu correo de contacto<\/span><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"@gmail.com\" id=\"forminator-field-email-1_6a02103ccdbe6\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" aria-describedby=\"forminator-field-email-1_6a02103ccdbe6-description\" \/><\/div><\/div><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6a02103ccdbe6\" id=\"forminator-field-text-2_6a02103ccdbe6-label\" class=\"forminator-label\">Where are you staying? <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-text-2_6a02103ccdbe6-description\" class=\"forminator-description\">Hotel name, Hostel, or Airbnb<\/span><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6a02103ccdbe6\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-2_6a02103ccdbe6-description\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6a02103ccdbe6\" id=\"forminator-field-text-1_6a02103ccdbe6-label\" class=\"forminator-label\">Emergency Contact (Name &amp; Phone) <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-text-1_6a02103ccdbe6-description\" class=\"forminator-description\">Who should we call in case of emergency?<\/span><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6a02103ccdbe6\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-1_6a02103ccdbe6-description\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-372294__field--select-2_6a02103ccdbe6\" id=\"forminator-form-372294__field--select-2_6a02103ccdbe6-label\" class=\"forminator-label\">Activity for Today <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-372294__field--select-2_6a02103ccdbe6\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Activity for Today\" data-search=\"false\" data-search-placeholder=\"Activity for Today\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-372294__field--select-2_6a02103ccdbe6-label\"><option value=\"\"  >Activity for Today<\/option><option value=\"Snorkeling\"  data-calculation=\"0\">Careteo<\/option><option value=\"Try-Scuba-Intro\"  data-calculation=\"0\">Try Scuba\/Intro<\/option><option value=\"Fun-Dive-(Certified)\"  data-calculation=\"0\">Fun Dive (Certified)<\/option><option value=\"Open-Water-Course\"  data-calculation=\"0\">Curso de aguas abiertas<\/option><option value=\"Advanced-Specialty\"  data-calculation=\"0\">Advanced\/Specialty<\/option><option value=\"Freediving\"  data-calculation=\"0\">Apnea<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-372294--page-2\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-372294--page-2-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"2\"\r\n\t\t\t\tdata-label=\"Participant Details &amp; Logistics\"\r\n\t\t\t\tdata-actual-label=\"Diver Medical\"\r\n\t\t\t\tdata-name=\"page-break-4\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-6a02103ccdbe6-label\" aria-describedby=\"forminator-radiogroup-radio-1-6a02103ccdbe6-description\"><span id=\"forminator-radiogroup-radio-1-6a02103ccdbe6-label\" class=\"forminator-label\">Lung\/Heart\/Blood History <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-1-6a02103ccdbe6-description\" class=\"forminator-description\">I have had problems with my lungs, breathing, heart and\/or blood affecting my normal physical or mental performance.<\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6a02103ccdbe6\" class=\"forminator-radio\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-1\" value=\"Yes\" id=\"forminator-field-radio-1-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-1-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6a02103ccdbe6\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-1\" value=\"No\" id=\"forminator-field-radio-1-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-1-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a02103ccdbe6-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6a02103ccdbe6-label\" class=\"forminator-label\">Box A - Please check ANY that apply to you: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-1-1-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-1-1-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Chest surgery, heart surgery, heart valve surgery, implantable medical device, pneumothorax, and\/or chronic lung disease.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Chest-surgery,-heart-surgery,-heart-valve-surgery,-implantable-medical-device,-pneumothorax,-and-or-chronic-lung-disease.\" id=\"forminator-field-checkbox-1-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-1-1-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Chest surgery, heart surgery, heart valve surgery, implantable medical device, pneumothorax, and\/or chronic lung disease.<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-1-2-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Asthma, wheezing, severe allergies, hay fever or congested airways within the last 12 months that limits my physical activity\/exercise.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Asthma,-wheezing,-severe-allergies,-hay-fever-or-congested-airways-within-the-last-12-months-that-limits-my-physical-activity-exercise.\" id=\"forminator-field-checkbox-1-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-1-2-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Asthma, wheezing, severe allergies, hay fever or congested airways within the last 12 months that limits my physical activity\/exercise.<\/span><\/label><label id=\"forminator-field-checkbox-1-3-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-1-3-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"A problem or illness involving my heart such as: angina, chest pain on exertion, heart failure, immersion pulmonary edema, heart attack or stroke, OR am taking medication for any heart condition.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"A-problem-or-illness-involving-my-heart-such-as:-angina,-chest-pain-on-exertion,-heart-failure,-immersion-pulmonary-edema,-heart-attack-or-stroke,-OR-am-taking-medication-for-any-heart-condition.\" id=\"forminator-field-checkbox-1-3-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-1-3-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">A problem or illness involving my heart such as: angina, chest pain on exertion, heart failure, immersion pulmonary edema, heart attack or stroke, OR am taking medication for any heart condition.<\/span><\/label><label id=\"forminator-field-checkbox-1-4-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-1-4-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Recurrent bronchitis and currently coughing within the past 12 months, OR have been diagnosed with emphysema.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Recurrent-bronchitis-and-currently-coughing-within-the-past-12-months,-OR-have-been-diagnosed-with-emphysema.\" id=\"forminator-field-checkbox-1-4-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-1-4-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Recurrent bronchitis and currently coughing within the past 12 months, OR have been diagnosed with emphysema.<\/span><\/label><label id=\"forminator-field-checkbox-1-5-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-1-5-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Symptoms affecting my lungs, breathing, heart and\/or blood in the last 30 days that impair my physical or mental performance.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Symptoms-affecting-my-lungs,-breathing,-heart-and-or-blood-in-the-last-30-days-that-impair-my-physical-or-mental-performance.\" id=\"forminator-field-checkbox-1-5-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-1-5-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Symptoms affecting my lungs, breathing, heart and\/or blood in the last 30 days that impair my physical or mental performance.<\/span><\/label><label id=\"forminator-field-checkbox-1-6-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-1-6-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"None of the above\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"None-of-the-above\" id=\"forminator-field-checkbox-1-6-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-1-6-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">None of the above<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-6a02103ccdbe6-label\" aria-describedby=\"forminator-radiogroup-radio-2-6a02103ccdbe6-description\"><span id=\"forminator-radiogroup-radio-2-6a02103ccdbe6-label\" class=\"forminator-label\">Over 45 Years Old <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-2-6a02103ccdbe6-description\" class=\"forminator-description\">Tengo m\u00e1s de 45 a\u00f1os de edad.<\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6a02103ccdbe6\" class=\"forminator-radio\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-2\" value=\"Yes\" id=\"forminator-field-radio-2-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-2-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6a02103ccdbe6\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-2\" value=\"No\" id=\"forminator-field-radio-2-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-2-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-2-6a02103ccdbe6-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-2-6a02103ccdbe6-label\" class=\"forminator-label\">Box B <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-2-1-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-2-1-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"I currently smoke or inhale nicotine by other means.\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"I-currently-smoke-or-inhale-nicotine-by-other-means.\" id=\"forminator-field-checkbox-2-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-2-1-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I currently smoke or inhale nicotine by other means.<\/span><\/label><label id=\"forminator-field-checkbox-2-2-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-2-2-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"I have a high cholesterol level.\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"I-have-a-high-cholesterol-level.\" id=\"forminator-field-checkbox-2-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-2-2-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I have a high cholesterol level.<\/span><\/label><label id=\"forminator-field-checkbox-2-3-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-2-3-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"I have high blood pressure.\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"I-have-high-blood-pressure.\" id=\"forminator-field-checkbox-2-3-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-2-3-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I have high blood pressure.<\/span><\/label><label id=\"forminator-field-checkbox-2-4-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-2-4-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"I have had a close blood relative die suddenly or of cardiac disease or stroke before the age of 50.\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"I-have-had-a-close-blood-relative-die-suddenly-or-of-cardiac-disease-or-stroke-before-the-age-of-50.\" id=\"forminator-field-checkbox-2-4-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-2-4-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I have had a close blood relative die suddenly or of cardiac disease or stroke before the age of 50.<\/span><\/label><label id=\"forminator-field-checkbox-2-5-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-2-5-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"None of the above\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"None-of-the-above\" id=\"forminator-field-checkbox-2-5-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-2-5-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">None of the above<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-3-6a02103ccdbe6-label\" aria-describedby=\"forminator-radiogroup-radio-3-6a02103ccdbe6-description\"><span id=\"forminator-radiogroup-radio-3-6a02103ccdbe6-label\" class=\"forminator-label\">Fitness \/ Exercise <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-3-6a02103ccdbe6-description\" class=\"forminator-description\">I struggle to perform moderate exercise (e.g., walk 1.6km in 14 mins or swim 200m without resting), OR I have been unable to participate in normal physical activity due to fitness\/health reasons within the past 12 months.<\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-6a02103ccdbe6\" class=\"forminator-radio\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-3\" value=\"Yes\" id=\"forminator-field-radio-3-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-3-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-6a02103ccdbe6\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-3\" value=\"No\" id=\"forminator-field-radio-3-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-3-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-4\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-4-6a02103ccdbe6-label\" aria-describedby=\"forminator-radiogroup-radio-4-6a02103ccdbe6-description\"><span id=\"forminator-radiogroup-radio-4-6a02103ccdbe6-label\" class=\"forminator-label\">Eyes\/Ears\/Sinus <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-4-6a02103ccdbe6-description\" class=\"forminator-description\">I have had problems with my eyes, ears, or nasal passages\/sinuses.<\/span><label id=\"forminator-field-radio-4-label-1\" for=\"forminator-field-radio-4-1-6a02103ccdbe6\" class=\"forminator-radio\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-4\" value=\"Yes\" id=\"forminator-field-radio-4-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-4-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-4-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-4-label-2\" for=\"forminator-field-radio-4-2-6a02103ccdbe6\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-4\" value=\"No\" id=\"forminator-field-radio-4-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-4-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-4-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-3-6a02103ccdbe6-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-3-6a02103ccdbe6-label\" class=\"forminator-label\">Box C - Please check ANY that apply to you: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-3-1-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-3-1-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Sinus surgery within the last 6 months.\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Sinus-surgery-within-the-last-6-months.\" id=\"forminator-field-checkbox-3-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-3-1-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Sinus surgery within the last 6 months.<\/span><\/label><label id=\"forminator-field-checkbox-3-2-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-3-2-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Ear disease or ear surgery, hearing loss, or problems with balance.\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Ear-disease-or-ear-surgery,-hearing-loss,-or-problems-with-balance.\" id=\"forminator-field-checkbox-3-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-3-2-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ear disease or ear surgery, hearing loss, or problems with balance.<\/span><\/label><label id=\"forminator-field-checkbox-3-3-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-3-3-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Recurrent sinusitis within the past 12 months.\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Recurrent-sinusitis-within-the-past-12-months.\" id=\"forminator-field-checkbox-3-3-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-3-3-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Recurrent sinusitis within the past 12 months.<\/span><\/label><label id=\"forminator-field-checkbox-3-4-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-3-4-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Eye surgery within the past 3 months.\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Eye-surgery-within-the-past-3-months.\" id=\"forminator-field-checkbox-3-4-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-3-4-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Eye surgery within the past 3 months.<\/span><\/label><label id=\"forminator-field-checkbox-3-5-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-3-5-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"None of the above\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"None-of-the-above\" id=\"forminator-field-checkbox-3-5-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-3-5-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">None of the above<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-5\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-5-6a02103ccdbe6-label\" aria-describedby=\"forminator-radiogroup-radio-5-6a02103ccdbe6-description\"><span id=\"forminator-radiogroup-radio-5-6a02103ccdbe6-label\" class=\"forminator-label\">Surgery <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-5-6a02103ccdbe6-description\" class=\"forminator-description\">Me he sometido a una cirug\u00eda en los \u00faltimos 12 meses, O tengo problemas continuos relacionados con una cirug\u00eda pasada.<\/span><label id=\"forminator-field-radio-5-label-1\" for=\"forminator-field-radio-5-1-6a02103ccdbe6\" class=\"forminator-radio\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-5\" value=\"Yes\" id=\"forminator-field-radio-5-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-5-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-5-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-5-label-2\" for=\"forminator-field-radio-5-2-6a02103ccdbe6\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-5\" value=\"No\" id=\"forminator-field-radio-5-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-5-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-5-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-6\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-6-6a02103ccdbe6-label\" aria-describedby=\"forminator-radiogroup-radio-6-6a02103ccdbe6-description\"><span id=\"forminator-radiogroup-radio-6-6a02103ccdbe6-label\" class=\"forminator-label\">Neurological <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-6-6a02103ccdbe6-description\" class=\"forminator-description\">He perdido el conocimiento, tenido migra\u00f1as, convulsiones, un derrame cerebral, una lesi\u00f3n grave en la cabeza o padezco una lesi\u00f3n o enfermedad neurol\u00f3gica persistente.<\/span><label id=\"forminator-field-radio-6-label-1\" for=\"forminator-field-radio-6-1-6a02103ccdbe6\" class=\"forminator-radio\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-6\" value=\"Yes\" id=\"forminator-field-radio-6-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-6-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-6-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-6-label-2\" for=\"forminator-field-radio-6-2-6a02103ccdbe6\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-6\" value=\"No\" id=\"forminator-field-radio-6-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-6-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-6-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-4\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-4-6a02103ccdbe6-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-4-6a02103ccdbe6-label\" class=\"forminator-label\">Box C - Please check ANY that apply to you: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-4-1-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-4-1-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Head injury with loss of consciousness within the past 5 years.\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Head-injury-with-loss-of-consciousness-within-the-past-5-years.\" id=\"forminator-field-checkbox-4-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-4-1-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Head injury with loss of consciousness within the past 5 years.<\/span><\/label><label id=\"forminator-field-checkbox-4-2-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-4-2-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Persistent neurologic injury or disease.\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Persistent-neurologic-injury-or-disease.\" id=\"forminator-field-checkbox-4-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-4-2-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Persistent neurologic injury or disease.<\/span><\/label><label id=\"forminator-field-checkbox-4-3-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-4-3-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Recurring migraine headaches within the past 12 months, or take medications to prevent them.\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Recurring-migraine-headaches-within-the-past-12-months,-or-take-medications-to-prevent-them.\" id=\"forminator-field-checkbox-4-3-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-4-3-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Recurring migraine headaches within the past 12 months, or take medications to prevent them.<\/span><\/label><label id=\"forminator-field-checkbox-4-4-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-4-4-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Blackouts or fainting (full\/partial loss of consciousness) within the last 5 years.\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Blackouts-or-fainting-(full-partial-loss-of-consciousness)-within-the-last-5-years.\" id=\"forminator-field-checkbox-4-4-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-4-4-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Blackouts or fainting (full\/partial loss of consciousness) within the last 5 years.<\/span><\/label><label id=\"forminator-field-checkbox-4-5-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-4-5-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Epilepsy, seizures, or convulsions, OR take medications to prevent them.\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Epilepsy,-seizures,-or-convulsions,-OR-take-medications-to-prevent-them.\" id=\"forminator-field-checkbox-4-5-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-4-5-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Epilepsy, seizures, or convulsions, OR take medications to prevent them.<\/span><\/label><label id=\"forminator-field-checkbox-4-6-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-4-6-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"None of the above\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"None-of-the-above\" id=\"forminator-field-checkbox-4-6-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-4-6-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">None of the above<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-7\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-7-6a02103ccdbe6-label\" aria-describedby=\"forminator-radiogroup-radio-7-6a02103ccdbe6-description\"><span id=\"forminator-radiogroup-radio-7-6a02103ccdbe6-label\" class=\"forminator-label\">Psychological <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-7-6a02103ccdbe6-description\" class=\"forminator-description\">I am currently undergoing treatment (or have required treatment within the last 5 years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol.<\/span><label id=\"forminator-field-radio-7-label-1\" for=\"forminator-field-radio-7-1-6a02103ccdbe6\" class=\"forminator-radio\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-7\" value=\"Yes\" id=\"forminator-field-radio-7-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-7-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-7-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-7-label-2\" for=\"forminator-field-radio-7-2-6a02103ccdbe6\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-7\" value=\"No\" id=\"forminator-field-radio-7-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-7-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-7-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-5\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-5-6a02103ccdbe6-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-5-6a02103ccdbe6-label\" class=\"forminator-label\">Box E - Please check ANY that apply to you: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-5-1-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-5-1-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Behavioral health, mental or psychological problems requiring medical\/psychiatric treatment.\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Behavioral-health,-mental-or-psychological-problems-requiring-medical-psychiatric-treatment.\" id=\"forminator-field-checkbox-5-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-5-1-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Behavioral health, mental or psychological problems requiring medical\/psychiatric treatment.<\/span><\/label><label id=\"forminator-field-checkbox-5-2-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-5-2-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Major depression, suicidal ideation, panic attacks, uncontrolled bipolar disorder requiring medication\/psychiatric treatment.\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Major-depression,-suicidal-ideation,-panic-attacks,-uncontrolled-bipolar-disorder-requiring-medication-psychiatric-treatment.\" id=\"forminator-field-checkbox-5-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-5-2-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Major depression, suicidal ideation, panic attacks, uncontrolled bipolar disorder requiring medication\/psychiatric treatment.<\/span><\/label><label id=\"forminator-field-checkbox-5-3-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-5-3-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Been diagnosed with a mental health condition or a learning\/developmental disorder that requires ongoing care or special accommodation.\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Been-diagnosed-with-a-mental-health-condition-or-a-learning-developmental-disorder-that-requires-ongoing-care-or-special-accommodation.\" id=\"forminator-field-checkbox-5-3-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-5-3-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Been diagnosed with a mental health condition or a learning\/developmental disorder that requires ongoing care or special accommodation.<\/span><\/label><label id=\"forminator-field-checkbox-5-4-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-5-4-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"An addiction to drugs or alcohol requiring treatment within the last 5 years.\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"An-addiction-to-drugs-or-alcohol-requiring-treatment-within-the-last-5-years.\" id=\"forminator-field-checkbox-5-4-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-5-4-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">An addiction to drugs or alcohol requiring treatment within the last 5 years.<\/span><\/label><label id=\"forminator-field-checkbox-5-5-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-5-5-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"None of the above\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"None-of-the-above\" id=\"forminator-field-checkbox-5-5-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-5-5-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">None of the above<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-8\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-8-6a02103ccdbe6-label\" aria-describedby=\"forminator-radiogroup-radio-8-6a02103ccdbe6-description\"><span id=\"forminator-radiogroup-radio-8-6a02103ccdbe6-label\" class=\"forminator-label\">Back\/Hernia\/Diabetes <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-8-6a02103ccdbe6-description\" class=\"forminator-description\">I have had back problems, hernia, ulcers, or diabetes.<\/span><label id=\"forminator-field-radio-8-label-1\" for=\"forminator-field-radio-8-1-6a02103ccdbe6\" class=\"forminator-radio\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-8\" value=\"Yes\" id=\"forminator-field-radio-8-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-8-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-8-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-8-label-2\" for=\"forminator-field-radio-8-2-6a02103ccdbe6\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-8\" value=\"No\" id=\"forminator-field-radio-8-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-8-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-8-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-6\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-6-6a02103ccdbe6-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-6-6a02103ccdbe6-label\" class=\"forminator-label\">Box F - Please check ANY that apply to you: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-6-1-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-6-1-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Recurrent back problems in the last 6 months that limit my everyday activity.\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Recurrent-back-problems-in-the-last-6-months-that-limit-my-everyday-activity.\" id=\"forminator-field-checkbox-6-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-6-1-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Recurrent back problems in the last 6 months that limit my everyday activity.<\/span><\/label><label id=\"forminator-field-checkbox-6-2-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-6-2-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Back or spinal surgery within the last 12 months.\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Back-or-spinal-surgery-within-the-last-12-months.\" id=\"forminator-field-checkbox-6-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-6-2-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Back or spinal surgery within the last 12 months.<\/span><\/label><label id=\"forminator-field-checkbox-6-3-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-6-3-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Diabetes, either drug or diet controlled, OR gestational diabetes within the last 12 months.\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Diabetes,-either-drug-or-diet-controlled,-OR-gestational-diabetes-within-the-last-12-months.\" id=\"forminator-field-checkbox-6-3-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-6-3-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Diabetes, either drug or diet controlled, OR gestational diabetes within the last 12 months.<\/span><\/label><label id=\"forminator-field-checkbox-6-4-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-6-4-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"An uncorrected hernia that limits my physical abilities.\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"An-uncorrected-hernia-that-limits-my-physical-abilities.\" id=\"forminator-field-checkbox-6-4-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-6-4-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">An uncorrected hernia that limits my physical abilities.<\/span><\/label><label id=\"forminator-field-checkbox-6-5-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-6-5-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Active or untreated ulcers, problem wounds, or ulcer surgery within the last 6 months.\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Active-or-untreated-ulcers,-problem-wounds,-or-ulcer-surgery-within-the-last-6-months.\" id=\"forminator-field-checkbox-6-5-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-6-5-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Active or untreated ulcers, problem wounds, or ulcer surgery within the last 6 months.<\/span><\/label><label id=\"forminator-field-checkbox-6-6-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-6-6-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"None of the above\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"None-of-the-above\" id=\"forminator-field-checkbox-6-6-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-6-6-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">None of the above<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-9\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-9-6a02103ccdbe6-label\" aria-describedby=\"forminator-radiogroup-radio-9-6a02103ccdbe6-description\"><span id=\"forminator-radiogroup-radio-9-6a02103ccdbe6-label\" class=\"forminator-label\">Stomach\/Intestine <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-9-6a02103ccdbe6-description\" class=\"forminator-description\">I have had stomach or intestine problems, including recent diarrhea.<\/span><label id=\"forminator-field-radio-9-label-1\" for=\"forminator-field-radio-9-1-6a02103ccdbe6\" class=\"forminator-radio\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-9\" value=\"Yes\" id=\"forminator-field-radio-9-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-9-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-9-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-9-label-2\" for=\"forminator-field-radio-9-2-6a02103ccdbe6\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-9\" value=\"No\" id=\"forminator-field-radio-9-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-9-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-9-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-7\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-7-6a02103ccdbe6-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-7-6a02103ccdbe6-label\" class=\"forminator-label\">Box G - Please check ANY that apply to you: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-7-1-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-7-1-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Ostomy surgery and do not have medical clearance to swim or engage in physical activity.\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Ostomy-surgery-and-do-not-have-medical-clearance-to-swim-or-engage-in-physical-activity.\" id=\"forminator-field-checkbox-7-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-7-1-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ostomy surgery and do not have medical clearance to swim or engage in physical activity.<\/span><\/label><label id=\"forminator-field-checkbox-7-2-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-7-2-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Dehydration requiring medical intervention within the last 7 days.\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Dehydration-requiring-medical-intervention-within-the-last-7-days.\" id=\"forminator-field-checkbox-7-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-7-2-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Dehydration requiring medical intervention within the last 7 days.<\/span><\/label><label id=\"forminator-field-checkbox-7-3-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-7-3-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Active or untreated stomach or intestinal ulcers or ulcer surgery within the last 6 months.\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Active-or-untreated-stomach-or-intestinal-ulcers-or-ulcer-surgery-within-the-last-6-months.\" id=\"forminator-field-checkbox-7-3-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-7-3-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Active or untreated stomach or intestinal ulcers or ulcer surgery within the last 6 months.<\/span><\/label><label id=\"forminator-field-checkbox-7-4-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-7-4-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Frequent heartburn, regurgitation, or gastroesophageal reflux disease (GERD).\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Frequent-heartburn,-regurgitation,-or-gastroesophageal-reflux-disease-(GERD).\" id=\"forminator-field-checkbox-7-4-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-7-4-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Frequent heartburn, regurgitation, or gastroesophageal reflux disease (GERD).<\/span><\/label><label id=\"forminator-field-checkbox-7-5-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-7-5-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Active or uncontrolled ulcerative colitis or Crohn&#039;s disease.\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Active-or-uncontrolled-ulcerative-colitis-or-Crohn&#039;s-disease.\" id=\"forminator-field-checkbox-7-5-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-7-5-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Active or uncontrolled ulcerative colitis or Crohn's disease.<\/span><\/label><label id=\"forminator-field-checkbox-7-6-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-7-6-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Bariatric surgery within the last 12 months.\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Bariatric-surgery-within-the-last-12-months.\" id=\"forminator-field-checkbox-7-6-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-7-6-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Bariatric surgery within the last 12 months.<\/span><\/label><label id=\"forminator-field-checkbox-7-7-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-7-7-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"None of the above\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"None-of-the-above\" id=\"forminator-field-checkbox-7-7-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-7-7-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">None of the above<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-10\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-10-6a02103ccdbe6-label\" aria-describedby=\"forminator-radiogroup-radio-10-6a02103ccdbe6-description\"><span id=\"forminator-radiogroup-radio-10-6a02103ccdbe6-label\" class=\"forminator-label\">Prescription Meds <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-10-6a02103ccdbe6-description\" class=\"forminator-description\">Estoy tomando medicamentos con prescripci\u00f3n m\u00e9dica (con la excepci\u00f3n de anticonceptivos o medicamentos contra la malaria distintos de mefloquina\/Lariam).<\/span><label id=\"forminator-field-radio-10-label-1\" for=\"forminator-field-radio-10-1-6a02103ccdbe6\" class=\"forminator-radio\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-10\" value=\"Yes\" id=\"forminator-field-radio-10-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-10-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-10-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-10-label-2\" for=\"forminator-field-radio-10-2-6a02103ccdbe6\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-10\" value=\"No\" id=\"forminator-field-radio-10-2-6a02103ccdbe6\" aria-labelledby=\"forminator-field-radio-10-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-10-6a02103ccdbe6-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-372294--page-3\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-372294--page-3-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"3\"\r\n\t\t\t\tdata-label=\"Diver Medical\"\r\n\t\t\t\tdata-actual-label=\"Waivers &amp; Agreements\"\r\n\t\t\t\tdata-name=\"\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"checkbox-8\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-8-6a02103ccdbe6-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-8-6a02103ccdbe6-label\" class=\"forminator-label\">Declaration of Understanding <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-8-6a02103ccdbe6-description\" class=\"forminator-description\">Through this document, I declare that I am a certified diver or a diving student under the control and supervision of a certified diving professional. I affirm that I understand that diving is considered a high-risk activity and its inherent hazards may result in serious injuries or death. Additionally, I understand and accept the risks associated with the motorboat trip to and from the dive site. I understand that these dangers include, but are not limited to, air expansion injuries, drowning, decompression sickness, slips or falls on the boat, cuts or injuries from another boat while I am in the water, injuries occurring while boarding or disembarking, and other sea-related risks. By signing this release of liability agreement, I certify that I am aware of and expressly assume the risks involved in conducting such dives, whether they are recreational dives or part of a diving course.<\/span><label id=\"forminator-field-checkbox-8-1-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-8-1-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Si, yo declaro:\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Yes,-I-declare\" id=\"forminator-field-checkbox-8-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-8-1-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-8-6a02103ccdbe6-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Si, yo declaro:<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-9\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-9-6a02103ccdbe6-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-9-6a02103ccdbe6-label\" class=\"forminator-label\">Acknowledgment of Risks <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-9-6a02103ccdbe6-description\" class=\"forminator-description\">By signing this form, I acknowledge that scuba diving and related activities involve inherent risks, including but not limited to: Decompression sickness, Air expansion injuries, Drowning, Boat-related accidents, and Other sea-related hazards.<\/span><label id=\"forminator-field-checkbox-9-1-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-9-1-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Acepto\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"I-acknowledge\" id=\"forminator-field-checkbox-9-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-9-1-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-9-6a02103ccdbe6-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Acepto<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-10\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-10-6a02103ccdbe6-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-10-6a02103ccdbe6-label\" class=\"forminator-label\">Voluntary Participation <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-10-6a02103ccdbe6-description\" class=\"forminator-description\">Entiendo y acepto estos riesgos, y elijo participar voluntariamente.<\/span><label id=\"forminator-field-checkbox-10-1-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-10-1-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Entiendo y acepto estos riesgos\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"I-understand-and-accept-these-risks\" id=\"forminator-field-checkbox-10-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-10-1-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-10-6a02103ccdbe6-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Entiendo y acepto estos riesgos<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-11\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-11-6a02103ccdbe6-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-11-6a02103ccdbe6-label\" class=\"forminator-label\">Exoneraci\u00f3n de responsabilidad <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-11-6a02103ccdbe6-description\" class=\"forminator-description\">Por la presente, libero a Ankla Azul Diving Center, a sus instructores, personal y afiliados de toda responsabilidad por lesiones personales, da\u00f1os a la propiedad o muerte accidental que surjan de mi participaci\u00f3n en actividades de buceo, independientemente de la causa.<\/span><label id=\"forminator-field-checkbox-11-1-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-11-1-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"I release Ankla Azul\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"I-release-Ankla-Azul\" id=\"forminator-field-checkbox-11-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-11-1-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-11-6a02103ccdbe6-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I release Ankla Azul<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-12\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-12-6a02103ccdbe6-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-12-6a02103ccdbe6-label\" class=\"forminator-label\">Objetos personales <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-12-6a02103ccdbe6-description\" class=\"forminator-description\">Ankla Azul no se hace responsable por la p\u00e9rdida o da\u00f1o de pertenencias personales llevadas a la actividad.<\/span><label id=\"forminator-field-checkbox-12-1-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-12-1-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Acepto\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"I-accept\" id=\"forminator-field-checkbox-12-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-12-1-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-12-6a02103ccdbe6-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Acepto<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-13\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-13-6a02103ccdbe6-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-13-6a02103ccdbe6-label\" class=\"forminator-label\">Responsabilidad del Equipo <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-13-6a02103ccdbe6-description\" class=\"forminator-description\">I agree to: Inspect all provided equipment before use. Return equipment in good condition or cover the cost of loss or damage.<\/span><label id=\"forminator-field-checkbox-13-1-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-13-1-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Acepto\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"I-agree\" id=\"forminator-field-checkbox-13-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-13-1-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-13-6a02103ccdbe6-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Acepto<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-14\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-14-6a02103ccdbe6-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-14-6a02103ccdbe6-label\" class=\"forminator-label\">Declaraci\u00f3n de salud <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-14-6a02103ccdbe6-description\" class=\"forminator-description\">Certifico que me encuentro en buen estado f\u00edsico y mental para bucear y que no estoy bajo la influencia de drogas o alcohol. Si tengo condiciones m\u00e9dicas, he consultado a un m\u00e9dico y obtenido autorizaci\u00f3n para bucear.<\/span><label id=\"forminator-field-checkbox-14-1-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-14-1-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"Certifico\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"I-certify\" id=\"forminator-field-checkbox-14-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-14-1-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-14-6a02103ccdbe6-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Certifico<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-15\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-15-6a02103ccdbe6-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-15-6a02103ccdbe6-label\" class=\"forminator-label\">Responsible Diver Pledge <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-15-6a02103ccdbe6-description\" class=\"forminator-description\">DIVE COMPETENTLY: Always dive within my training and ability.  MAINTAIN HEALTH: Appropriate fitness and mental awareness.  DIVE PLAN: Plan my dive and dive my plan.  DIVE PARTNER: Remain with my partner from start to finish.  INSPECT EQUIPMENT: Before each dive, I will inspect my equipment.  DIVER AWARENESS: Monitor gas, depth, and time.  RESPECT ENVIRONMENT: Be aware of currents and marine life.  PLAN FOR EMERGENCIES: Know how to alert others.  ACCEPT RESPONSIBILITY: I am ultimately responsible for my safety.<\/span><label id=\"forminator-field-checkbox-15-1-6a02103ccdbe6-label\" for=\"forminator-field-checkbox-15-1-6a02103ccdbe6\" class=\"forminator-checkbox\" title=\"I Pledge\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"I-Pledge\" id=\"forminator-field-checkbox-15-1-6a02103ccdbe6\" aria-labelledby=\"forminator-field-checkbox-15-1-6a02103ccdbe6-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-15-6a02103ccdbe6-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I Pledge<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-2\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_6a02103ccdbe6\" id=\"forminator-field-date-2-picker_6a02103ccdbe6-label\" class=\"forminator-label\">Date <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"11-05-2026\" placeholder=\"Elige fecha\" id=\"forminator-field-date-2-picker_6a02103ccdbe6\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"2026\" data-end-year=\"2026\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"2026-05-11\" data-end-date=\"12\/31\/2026\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"signature-1\" class=\"forminator-field-signature forminator-col forminator-col-12\"><div class=\"forminator-field forminator-field-signature\"><label for=\"forminator-field-ctlSignature6a02103cd0798\" id=\"forminator-field-ctlSignature6a02103cd0798-label\" class=\"forminator-label\">Participant Signature <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-ctlSignature6a02103cd0798-description\" class=\"forminator-description\">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.<\/span><div class=\"forminator-signature\" data-elementheight=\"180\" aria-describedby=\"forminator-field-ctlSignature6a02103cd0798-description\"><span id=\"ctlSignature6a02103cd0798_placeholder\" class=\"forminator-signature--placeholder\" aria-hidden=\"true\"><\/span><div id=\"ctlSignature6a02103cd0798_Container\" class=\"forminator-signature--container\"><canvas id=\"ctlSignature6a02103cd0798\" class=\"forminator-signature-canvas\" height=\"180\" tabindex=\"-1\"><p>Your browser does not support e-Signature field.<\/p><\/canvas><\/div><\/div><input type=\"hidden\" name=\"field-signature-1\" value=\"6a02103cd0798\" class=\"signature-prefix\"><\/div><\/div><\/div><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>Cargar<\/button><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"16000dc6be\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/es\/wp-json\/wp\/v2\/pages\/375819\" \/><input type=\"hidden\" name=\"form_id\" value=\"372294\"><input type=\"hidden\" name=\"page_id\" value=\"375819\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/anklaazul.com\/es\/liability-waiver\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><label for=\"input_35\" class=\"forminator-hidden\" aria-hidden=\"true\">Por favor, no rellenes este campo. <input id=\"input_35\" type=\"text\" name=\"input_35\" value=\"\" autocomplete=\"off\"><\/label><input type=\"hidden\" name=\"trp-form-language\" value=\"es\"\/><\/form>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_section_2 et_pb_section et_section_regular et_flex_section et-interaction-target-frv8uqomgs preset--module--divi-section--n39wc5psvj\" data-interaction-target=\"frv8uqomgs\" id=\"Sp\">\n<div class=\"et_pb_row_2 et_pb_row et_flex_row preset--module--divi-row--oq2ebt1ewh\">\n<div class=\"et_pb_column_2 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone et_flex_column_24_24_phoneWide et_flex_column_24_24_tabletWide preset--module--divi-column--ob6j6wcd7d\">\n<div class=\"et_pb_icon_1 et_pb_icon et_pb_module et_flex_module preset--module--divi-icon--4sr05b39e7\" data-interaction-trigger=\"tac402zioc\"><span class=\"et_pb_icon_wrap\"><span class=\"et-pb-icon\">\uf00d<\/span><\/span>\n<div class=\"et_pb_text_4 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module preset--module--divi-text--3tx68shv89\" data-interaction-trigger=\"ltqvt11a9n\"><div class=\"et_pb_text_inner\"><p>Cerrar Formulario<\/p>\n<\/div><\/div>\n<\/div>\n\n<div class=\"et_pb_text_5 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module preset--module--divi-text--icujiwwkuf\"><div class=\"et_pb_text_inner\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-378573 forminator-design--bold forminator-enclosed\" data-forminator-render=\"0\" data-form=\"forminator-module-378573\" data-uid=\"6a02103cdd5d5\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-378573\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-378573 forminator-design--bold forminator-enclosed\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"378573\"\r\n\t\t\t\t data-color-option=\"theme\" data-design=\"bold\" data-grid=\"enclosed\" style=\"display: none;\"\r\n\t\t\t\tdata-uid=\"6a02103cdd5d5\" action=\"\"\r\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div role=\"tablist\" class=\"forminator-pagination-steps\" aria-label=\"Pagination\"><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-378573--page-0\"\r\n\t\t\t\tclass=\"forminator-pagination forminator-pagination-start\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-378573--page-0-label\"\r\n\t\t\t\tdata-step=\"0\"\r\n\t\t\t\tdata-label=\"Exoneraciones &amp; Acuerdos\"\r\n\t\t\t\tdata-actual-label=\"Bienvenida &amp; Compromiso Ecol\u00f3gico\"\r\n\t\t\t\tdata-name=\"page-break-5\"\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><label class=\"forminator-label\">Mensaje de Bienvenida<\/label><div style=\"text-align: center;padding: 30px;background-color: #f0fdf4;border: 2px solid #22c55e;border-radius: 10px;margin-bottom: 20px\">\n  <h2 style=\"color: #15803d;margin-top: 0\">Bienvenido a Ankla Azul<\/h2>\n  <h4 style=\"color: #16a34a;margin-top: 5px;font-weight: bold\">Centro de Buceo Blue Ocean<\/h4>\n  <p style=\"font-size: 1.1em;color: #374151\">Estamos comprometidos con la protecci\u00f3n de nuestro medio ambiente marino.<\/p>\n  <p>Para apoyar los esfuerzos de conservaci\u00f3n y <strong>reducir el desperdicio de papel<\/strong>, hemos hecho la transici\u00f3n a este proceso de registro 100% digital. Al completar esto digitalmente, nos ayudas a minimizar nuestra huella ecol\u00f3gica.<\/p>\n  <p style=\"font-weight: bold;color: #15803d;margin-top: 15px\">\u00a1Gracias por ayudarnos a mantener nuestros oc\u00e9anos limpios!<\/p>\n<\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-2\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><label class=\"forminator-label\">Advertencia de Seguridad<\/label><div style=\"background-color: #f0f9ff;border-left: 5px solid #0ea5e9;padding: 20px;border-radius: 5px;margin-bottom: 20px\">\n  <h3 style=\"margin-top:0;color: #0284c7;font-size: 18px;font-weight: bold\">IMPORTANTE: LEA DETENIDAMENTE<\/h3>\n  <p style=\"margin-bottom: 10px\">Su seguridad es nuestra prioridad.<\/p>\n  <p>Antes de comenzar su aventura, debe completar esta <strong>Liberaci\u00f3n de Responsabilidad<\/strong> y <strong>Declaraci\u00f3n M\u00e9dica<\/strong>.<\/p>\n  <ul style=\"margin-left: 20px;margin-bottom: 10px\">\n    <li><strong>VERACIDAD:<\/strong> Debe responder a todas las preguntas con la <strong>verdad<\/strong>. Ocultar informaci\u00f3n sobre su historial m\u00e9dico puede resultar en lesiones graves o la muerte bajo el agua.<\/li>\n    <li><strong>DOCUMENTO LEGAL:<\/strong> Este es un contrato legalmente vinculante. Deber\u00e1 <strong>firmar<\/strong> al final para confirmar que toda la informaci\u00f3n es correcta.<\/li>\n  <\/ul>\n  <p style=\"font-style: italic;color: #0284c7\">Al completar este formulario, acepta dar respuestas honestas por su propia seguridad.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-378573--page-1\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-378573--page-1-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"1\"\r\n\t\t\t\tdata-label=\"Bienvenida &amp; Compromiso Ecol\u00f3gico\"\r\n\t\t\t\tdata-actual-label=\"Datos del Participante &amp; Log\u00edstica\"\r\n\t\t\t\tdata-name=\"page-break-1\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-12\"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-first-name-2_6a02103cdd5d5\" id=\"forminator-field-first-name-2_6a02103cdd5d5-label\" class=\"forminator-label\">Nombre Completo <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2-first-name\" placeholder=\"E.j John\" id=\"forminator-field-first-name-2_6a02103cdd5d5\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"given-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-last-name-2_6a02103cdd5d5\" id=\"forminator-field-last-name-2_6a02103cdd5d5-label\" class=\"forminator-label\">Apellido <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2-last-name\" placeholder=\"E.j P\u00e9rez\" id=\"forminator-field-last-name-2_6a02103cdd5d5\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"family-name\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6\"><label for=\"forminator-field-date-1\" id=\"forminator-field-date-1-label\" class=\"forminator-label\">Fecha de Nacimiento <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-date-select\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-1-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-378573__field--date-1-day_6a02103cdd5d5\" id=\"forminator-field-378573__field--date-1-day_6a02103cdd5d5-label\" class=\"forminator-label\">D\u00eda<\/label><select name=\"date-1-day\" id=\"forminator-field-378573__field--date-1-day_6a02103cdd5d5\" class=\"forminator-select2\" data-format=\"dd\/mm\/yy\" data-parent=\"date-1\" aria-describedby=\"forminator-field-date-1_6a02103cdd5d5-description\" aria-labelledby=\"forminator-field-378573__field--date-1-day_6a02103cdd5d5-label\" data-default-value=\"\"><option value=\"\" selected=\"selected\">Seleccionar un d\u00eda<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><\/div><\/div><div id=\"date-1-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-378573__field--date-1-month_6a02103cdd5d5\" id=\"forminator-field-378573__field--date-1-month_6a02103cdd5d5-label\" class=\"forminator-label\">Mes<\/label><select name=\"date-1-month\" id=\"forminator-field-378573__field--date-1-month_6a02103cdd5d5\" class=\"forminator-select2\" data-format=\"dd\/mm\/yy\" data-parent=\"date-1\" aria-describedby=\"forminator-field-date-1_6a02103cdd5d5-description\" aria-labelledby=\"forminator-field-378573__field--date-1-month_6a02103cdd5d5-label\" data-default-value=\"\"><option value=\"\" selected=\"selected\">Seleccionar mes<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><\/div><\/div><div id=\"date-1-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-378573__field--date-1-year_6a02103cdd5d5\" id=\"forminator-field-378573__field--date-1-year_6a02103cdd5d5-label\" class=\"forminator-label\">A\u00f1o<\/label><select name=\"date-1-year\" id=\"forminator-field-378573__field--date-1-year_6a02103cdd5d5\" class=\"forminator-select2\" data-format=\"dd\/mm\/yy\" data-parent=\"date-1\" aria-describedby=\"forminator-field-date-1_6a02103cdd5d5-description\" aria-labelledby=\"forminator-field-378573__field--date-1-year_6a02103cdd5d5-label\" data-default-value=\"\"><option value=\"\" selected=\"selected\">Seleccionar a\u00f1o<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><\/select><\/div><\/div><\/div><\/div><span id=\"forminator-field-date-1_6a02103cdd5d5-description\" class=\"forminator-description\">Ingresa tu fecha de nacimiento<\/span><\/div><div id=\"phone-4\" class=\"forminator-field-phone forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-4_6a02103cdd5d5\" id=\"forminator-field-phone-4_6a02103cdd5d5-label\" class=\"forminator-label\">Tel\u00e9fono <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-phone-4_6a02103cdd5d5-description\" class=\"forminator-description\">Tu n\u00famero de contacto<\/span><input type=\"text\" name=\"phone-4\" value=\"\" placeholder=\"Tel\u00e9fono \/ WhatsApp\" id=\"forminator-field-phone-4_6a02103cdd5d5\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"tel-national\" data-national_mode=\"disabled\" data-country=\"co\" data-validation=\"international\" aria-describedby=\"forminator-field-phone-4_6a02103cdd5d5-description\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a02103cdd5d5\" id=\"forminator-field-email-1_6a02103cdd5d5-label\" class=\"forminator-label\">Correo Electr\u00f3nico <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-email-1_6a02103cdd5d5-description\" class=\"forminator-description\">Tu correo electr\u00f3nico de contacto<\/span><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"@gmail.com\" id=\"forminator-field-email-1_6a02103cdd5d5\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" aria-describedby=\"forminator-field-email-1_6a02103cdd5d5-description\" \/><\/div><\/div><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6a02103cdd5d5\" id=\"forminator-field-text-2_6a02103cdd5d5-label\" class=\"forminator-label\">\u00bfEn d\u00f3nde te hospedas? <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-text-2_6a02103cdd5d5-description\" class=\"forminator-description\">Nombre del Hotel, Hostal o Airbnb<\/span><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6a02103cdd5d5\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-2_6a02103cdd5d5-description\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6a02103cdd5d5\" id=\"forminator-field-text-1_6a02103cdd5d5-label\" class=\"forminator-label\">Contacto de Emergencia <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-text-1_6a02103cdd5d5-description\" class=\"forminator-description\">\u00bfA qui\u00e9n debemos llamar en caso de emergencia?<\/span><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6a02103cdd5d5\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-1_6a02103cdd5d5-description\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-378573__field--select-2_6a02103cdd5d5\" id=\"forminator-form-378573__field--select-2_6a02103cdd5d5-label\" class=\"forminator-label\">Actividad de Hoy <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-378573__field--select-2_6a02103cdd5d5\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Actividad de Hoy\" data-search=\"false\" data-search-placeholder=\"Actividad de Hoy\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-378573__field--select-2_6a02103cdd5d5-label\"><option value=\"\"  >Actividad de Hoy<\/option><option value=\"Snorkel\"  data-calculation=\"0\">Careteo<\/option><option value=\"Mini Curso\"  data-calculation=\"0\">Mini Curso<\/option><option value=\"Fun Dive (Certificado)\"  data-calculation=\"0\">Fun Dive (Certificado)<\/option><option value=\"Curso Open Water\"  data-calculation=\"0\">Curso Open Water<\/option><option value=\"Curso Avanzado \/ Especialidad\"  data-calculation=\"0\">Curso Avanzado \/ Especialidad<\/option><option value=\"Apnea\"  data-calculation=\"0\">Apnea<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-378573--page-2\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-378573--page-2-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"2\"\r\n\t\t\t\tdata-label=\"Datos del Participante &amp; Log\u00edstica\"\r\n\t\t\t\tdata-actual-label=\"Historia M\u00e9dica\"\r\n\t\t\t\tdata-name=\"page-break-4\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-6a02103cdd5d5-label\" aria-describedby=\"forminator-radiogroup-radio-1-6a02103cdd5d5-description\"><span id=\"forminator-radiogroup-radio-1-6a02103cdd5d5-label\" class=\"forminator-label\">Historial de pulmones\/coraz\u00f3n\/sangre <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-1-6a02103cdd5d5-description\" class=\"forminator-description\">He tenido problemas con mis pulmones, respiraci\u00f3n, coraz\u00f3n y\/o sangre que afectan mi desempe\u00f1o f\u00edsico o mental normal.<\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6a02103cdd5d5\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-1\" value=\"Si\" id=\"forminator-field-radio-1-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-1-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6a02103cdd5d5\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-1\" value=\"No\" id=\"forminator-field-radio-1-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-1-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a02103cdd5d5-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6a02103cdd5d5-label\" class=\"forminator-label\">Caja A - Por favor marque CUALQUIERA que aplique: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-1-1-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-1-1-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Cirug\u00eda tor\u00e1cica, cirug\u00eda card\u00edaca, cirug\u00eda de v\u00e1lvulas card\u00edacas, dispositivo m\u00e9dico implantable, neumot\u00f3rax y\/o enfermedad pulmonar cr\u00f3nica.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Cirug\u00eda tor\u00e1cica, cirug\u00eda card\u00edaca, cirug\u00eda de v\u00e1lvulas card\u00edacas, dispositivo m\u00e9dico implantable, neumot\u00f3rax y\/o enfermedad pulmonar cr\u00f3nica.\" id=\"forminator-field-checkbox-1-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-1-1-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Cirug\u00eda tor\u00e1cica, cirug\u00eda card\u00edaca, cirug\u00eda de v\u00e1lvulas card\u00edacas, dispositivo m\u00e9dico implantable, neumot\u00f3rax y\/o enfermedad pulmonar cr\u00f3nica.<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-1-2-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Asma, sibilancias, alergias graves, fiebre del heno o v\u00edas respiratorias congestionadas en los \u00faltimos 12 meses que limitan mi actividad f\u00edsica\/ejercicio.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Asma, sibilancias, alergias graves, fiebre del heno o v\u00edas respiratorias congestionadas en los \u00faltimos 12 meses que limitan mi actividad f\u00edsica\/ejercicio.\" id=\"forminator-field-checkbox-1-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-1-2-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Asma, sibilancias, alergias graves, fiebre del heno o v\u00edas respiratorias congestionadas en los \u00faltimos 12 meses que limitan mi actividad f\u00edsica\/ejercicio.<\/span><\/label><label id=\"forminator-field-checkbox-1-3-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-1-3-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Alg\u00fan problema o enfermedad que afecte a mi coraz\u00f3n, tal como: angina de pecho, dolor de pecho al hacer esfuerzo, insuficiencia card\u00edaca, edema pulmonar por inmersi\u00f3n, ataque al coraz\u00f3n o ictus, O estoy tomando medicaci\u00f3n para alguna afecci\u00f3n card\u00edaca.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Alg\u00fan problema o enfermedad que afecte a mi coraz\u00f3n, tal como: angina de pecho, dolor de pecho al hacer esfuerzo, insuficiencia card\u00edaca, edema pulmonar por inmersi\u00f3n, ataque al coraz\u00f3n o ictus, O estoy tomando medicaci\u00f3n para alguna afecci\u00f3n card\u00edaca.\" id=\"forminator-field-checkbox-1-3-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-1-3-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Alg\u00fan problema o enfermedad que afecte a mi coraz\u00f3n, tal como: angina de pecho, dolor de pecho al hacer esfuerzo, insuficiencia card\u00edaca, edema pulmonar por inmersi\u00f3n, ataque al coraz\u00f3n o ictus, O estoy tomando medicaci\u00f3n para alguna afecci\u00f3n card\u00edaca.<\/span><\/label><label id=\"forminator-field-checkbox-1-4-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-1-4-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Bronquitis recurrente y tos actual en los \u00faltimos 12 meses, O me han diagnosticado enfisema.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Bronquitis recurrente y tos actual en los \u00faltimos 12 meses, O me han diagnosticado enfisema.\" id=\"forminator-field-checkbox-1-4-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-1-4-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Bronquitis recurrente y tos actual en los \u00faltimos 12 meses, O me han diagnosticado enfisema.<\/span><\/label><label id=\"forminator-field-checkbox-1-5-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-1-5-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"S\u00edntomas que afectan a mis pulmones, respiraci\u00f3n, coraz\u00f3n y\/o sangre en los \u00faltimos 30 d\u00edas que merman mi rendimiento f\u00edsico o mental.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"S\u00edntomas que afectan a mis pulmones, respiraci\u00f3n, coraz\u00f3n y\/o sangre en los \u00faltimos 30 d\u00edas que merman mi rendimiento f\u00edsico o mental.\" id=\"forminator-field-checkbox-1-5-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-1-5-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">S\u00edntomas que afectan a mis pulmones, respiraci\u00f3n, coraz\u00f3n y\/o sangre en los \u00faltimos 30 d\u00edas que merman mi rendimiento f\u00edsico o mental.<\/span><\/label><label id=\"forminator-field-checkbox-1-6-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-1-6-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Ninguna de las anteriores\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Ninguna de las anteriores\" id=\"forminator-field-checkbox-1-6-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-1-6-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ninguna de las anteriores<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-6a02103cdd5d5-label\" aria-describedby=\"forminator-radiogroup-radio-2-6a02103cdd5d5-description\"><span id=\"forminator-radiogroup-radio-2-6a02103cdd5d5-label\" class=\"forminator-label\">Mayor de 45 a\u00f1os <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-2-6a02103cdd5d5-description\" class=\"forminator-description\">Tengo m\u00e1s de 45 a\u00f1os<\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6a02103cdd5d5\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-2\" value=\"Si\" id=\"forminator-field-radio-2-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-2-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6a02103cdd5d5\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-2\" value=\"No\" id=\"forminator-field-radio-2-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-2-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-2-6a02103cdd5d5-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-2-6a02103cdd5d5-label\" class=\"forminator-label\">Caja B - Por favor marque CUALQUIERA que aplique: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-2-1-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-2-1-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Fumo actualmente o inhalo nicotina por otros medios.\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Fumo actualmente o inhalo nicotina por otros medios.\" id=\"forminator-field-checkbox-2-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-2-1-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Fumo actualmente o inhalo nicotina por otros medios.<\/span><\/label><label id=\"forminator-field-checkbox-2-2-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-2-2-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Tengo el nivel de colesterol alto.\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Tengo el nivel de colesterol alto.\" id=\"forminator-field-checkbox-2-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-2-2-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Tengo el nivel de colesterol alto.<\/span><\/label><label id=\"forminator-field-checkbox-2-3-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-2-3-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Tengo la tensi\u00f3n arterial alta.\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Tengo la tensi\u00f3n arterial alta.\" id=\"forminator-field-checkbox-2-3-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-2-3-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Tengo la tensi\u00f3n arterial alta.<\/span><\/label><label id=\"forminator-field-checkbox-2-4-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-2-4-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"He tenido un pariente consangu\u00edneo cercano que haya muerto repentinamente o de enfermedad card\u00edaca o ictus antes de los 50 a\u00f1os.\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"He tenido un pariente consangu\u00edneo cercano que haya muerto repentinamente o de enfermedad card\u00edaca o ictus antes de los 50 a\u00f1os.\" id=\"forminator-field-checkbox-2-4-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-2-4-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">He tenido un pariente consangu\u00edneo cercano que haya muerto repentinamente o de enfermedad card\u00edaca o ictus antes de los 50 a\u00f1os.<\/span><\/label><label id=\"forminator-field-checkbox-2-5-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-2-5-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Ninguna de las anteriores.\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Ninguna de las anteriores.\" id=\"forminator-field-checkbox-2-5-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-2-5-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ninguna de las anteriores.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-3-6a02103cdd5d5-label\" aria-describedby=\"forminator-radiogroup-radio-3-6a02103cdd5d5-description\"><span id=\"forminator-radiogroup-radio-3-6a02103cdd5d5-label\" class=\"forminator-label\">Estado F\u00edsico <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-3-6a02103cdd5d5-description\" class=\"forminator-description\">Me cuesta realizar ejercicio moderado (por ejemplo, caminar 1,6 kil\u00f3metros en 14 minutos o nadar 200 metros sin descansar), O no he podido participar en una actividad f\u00edsica normal debido a razones de estado f\u00edsico o de salud en los \u00faltimos 12 meses.<\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-6a02103cdd5d5\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-3\" value=\"Si\" id=\"forminator-field-radio-3-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-3-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-6a02103cdd5d5\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-3\" value=\"No\" id=\"forminator-field-radio-3-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-3-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-4\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-4-6a02103cdd5d5-label\" aria-describedby=\"forminator-radiogroup-radio-4-6a02103cdd5d5-description\"><span id=\"forminator-radiogroup-radio-4-6a02103cdd5d5-label\" class=\"forminator-label\">Ojos\/O\u00eddos\/Senos nasales <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-4-6a02103cdd5d5-description\" class=\"forminator-description\">He tenido problemas con mis ojos, o\u00eddos, o fosas nasales \/ senos paranasales.<\/span><label id=\"forminator-field-radio-4-label-1\" for=\"forminator-field-radio-4-1-6a02103cdd5d5\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-4\" value=\"Si\" id=\"forminator-field-radio-4-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-4-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-4-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-4-label-2\" for=\"forminator-field-radio-4-2-6a02103cdd5d5\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-4\" value=\"No\" id=\"forminator-field-radio-4-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-4-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-4-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-3-6a02103cdd5d5-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-3-6a02103cdd5d5-label\" class=\"forminator-label\">Caja C - Por favor marque CUALQUIERA que aplique: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-3-1-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-3-1-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Cirug\u00eda de senos paranasales en los \u00faltimos 6 meses.\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Cirug\u00eda de senos paranasales en los \u00faltimos 6 meses.\" id=\"forminator-field-checkbox-3-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-3-1-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Cirug\u00eda de senos paranasales en los \u00faltimos 6 meses.<\/span><\/label><label id=\"forminator-field-checkbox-3-2-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-3-2-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Enfermedad del o\u00eddo o cirug\u00eda del o\u00eddo, p\u00e9rdida de audici\u00f3n o problemas de equilibrio.\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Enfermedad del o\u00eddo o cirug\u00eda del o\u00eddo, p\u00e9rdida de audici\u00f3n o problemas de equilibrio.\" id=\"forminator-field-checkbox-3-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-3-2-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Enfermedad del o\u00eddo o cirug\u00eda del o\u00eddo, p\u00e9rdida de audici\u00f3n o problemas de equilibrio.<\/span><\/label><label id=\"forminator-field-checkbox-3-3-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-3-3-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Sinusitis recurrente en los \u00faltimos 12 meses.\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Sinusitis recurrente en los \u00faltimos 12 meses.\" id=\"forminator-field-checkbox-3-3-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-3-3-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Sinusitis recurrente en los \u00faltimos 12 meses.<\/span><\/label><label id=\"forminator-field-checkbox-3-4-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-3-4-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Cirug\u00eda ocular en los \u00faltimos 3 meses.\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Cirug\u00eda ocular en los \u00faltimos 3 meses.\" id=\"forminator-field-checkbox-3-4-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-3-4-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Cirug\u00eda ocular en los \u00faltimos 3 meses.<\/span><\/label><label id=\"forminator-field-checkbox-3-5-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-3-5-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Ninguna de las anteriores.\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Ninguna de las anteriores.\" id=\"forminator-field-checkbox-3-5-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-3-5-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ninguna de las anteriores.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-5\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-5-6a02103cdd5d5-label\" aria-describedby=\"forminator-radiogroup-radio-5-6a02103cdd5d5-description\"><span id=\"forminator-radiogroup-radio-5-6a02103cdd5d5-label\" class=\"forminator-label\">Cirug\u00eda <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-5-6a02103cdd5d5-description\" class=\"forminator-description\">He tenido una cirug\u00eda en los \u00faltimos 12 meses, O tengo problemas continuos relacionados con una cirug\u00eda anterior.<\/span><label id=\"forminator-field-radio-5-label-1\" for=\"forminator-field-radio-5-1-6a02103cdd5d5\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-5\" value=\"Si\" id=\"forminator-field-radio-5-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-5-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-5-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-5-label-2\" for=\"forminator-field-radio-5-2-6a02103cdd5d5\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-5\" value=\"No\" id=\"forminator-field-radio-5-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-5-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-5-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-6\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-6-6a02103cdd5d5-label\" aria-describedby=\"forminator-radiogroup-radio-6-6a02103cdd5d5-description\"><span id=\"forminator-radiogroup-radio-6-6a02103cdd5d5-label\" class=\"forminator-label\">Neurol\u00f3gico <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-6-6a02103cdd5d5-description\" class=\"forminator-description\">He perdido el conocimiento, he tenido dolores de cabeza por migra\u00f1a, convulsiones, accidente cerebrovascular, lesi\u00f3n significativa en la cabeza, o he sufrido de lesi\u00f3n o enfermedad neurol\u00f3gica persistente.<\/span><label id=\"forminator-field-radio-6-label-1\" for=\"forminator-field-radio-6-1-6a02103cdd5d5\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-6\" value=\"Si\" id=\"forminator-field-radio-6-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-6-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-6-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-6-label-2\" for=\"forminator-field-radio-6-2-6a02103cdd5d5\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-6\" value=\"No\" id=\"forminator-field-radio-6-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-6-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-6-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-4\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-4-6a02103cdd5d5-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-4-6a02103cdd5d5-label\" class=\"forminator-label\">Caja D - Por favor marque CUALQUIERA que aplique: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-4-1-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-4-1-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Lesi\u00f3n en la cabeza con p\u00e9rdida del conocimiento en los \u00faltimos 5 a\u00f1os.\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Lesi\u00f3n en la cabeza con p\u00e9rdida del conocimiento en los \u00faltimos 5 a\u00f1os.\" id=\"forminator-field-checkbox-4-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-4-1-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Lesi\u00f3n en la cabeza con p\u00e9rdida del conocimiento en los \u00faltimos 5 a\u00f1os.<\/span><\/label><label id=\"forminator-field-checkbox-4-2-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-4-2-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Lesi\u00f3n o enfermedad neurol\u00f3gica persistente.\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Lesi\u00f3n o enfermedad neurol\u00f3gica persistente.\" id=\"forminator-field-checkbox-4-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-4-2-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Lesi\u00f3n o enfermedad neurol\u00f3gica persistente.<\/span><\/label><label id=\"forminator-field-checkbox-4-3-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-4-3-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Dolores de cabeza por migra\u00f1a recurrentes en los \u00faltimos 12 meses, o tomo medicamentos para prevenirlos.\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Dolores de cabeza por migra\u00f1a recurrentes en los \u00faltimos 12 meses, o tomo medicamentos para prevenirlos.\" id=\"forminator-field-checkbox-4-3-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-4-3-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Dolores de cabeza por migra\u00f1a recurrentes en los \u00faltimos 12 meses, o tomo medicamentos para prevenirlos.<\/span><\/label><label id=\"forminator-field-checkbox-4-4-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-4-4-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Desmayos o desvanecimientos (p\u00e9rdida total\/parcial del conocimiento) en los \u00faltimos 5 a\u00f1os.\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Desmayos o desvanecimientos (p\u00e9rdida total\/parcial del conocimiento) en los \u00faltimos 5 a\u00f1os.\" id=\"forminator-field-checkbox-4-4-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-4-4-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Desmayos o desvanecimientos (p\u00e9rdida total\/parcial del conocimiento) en los \u00faltimos 5 a\u00f1os.<\/span><\/label><label id=\"forminator-field-checkbox-4-5-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-4-5-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Epilepsia, convulsiones o ataques, O tomo medicamentos para prevenirlos.\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Epilepsia, convulsiones o ataques, O tomo medicamentos para prevenirlos.\" id=\"forminator-field-checkbox-4-5-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-4-5-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Epilepsia, convulsiones o ataques, O tomo medicamentos para prevenirlos.<\/span><\/label><label id=\"forminator-field-checkbox-4-6-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-4-6-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Ninguna de las anteriores.\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Ninguna de las anteriores.\" id=\"forminator-field-checkbox-4-6-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-4-6-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ninguna de las anteriores.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-7\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-7-6a02103cdd5d5-label\" aria-describedby=\"forminator-radiogroup-radio-7-6a02103cdd5d5-description\"><span id=\"forminator-radiogroup-radio-7-6a02103cdd5d5-label\" class=\"forminator-label\">Psicol\u00f3gico <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-7-6a02103cdd5d5-description\" class=\"forminator-description\">He tenido problemas psicol\u00f3gicos (o he recibido tratamiento psicol\u00f3gico en los \u00faltimos 5 a\u00f1os), me diagnosticaron una discapacidad de aprendizaje, trastorno de la personalidad, ataques de p\u00e1nico o una adicci\u00f3n a las drogas o el alcohol.<\/span><label id=\"forminator-field-radio-7-label-1\" for=\"forminator-field-radio-7-1-6a02103cdd5d5\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-7\" value=\"Si\" id=\"forminator-field-radio-7-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-7-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-7-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-7-label-2\" for=\"forminator-field-radio-7-2-6a02103cdd5d5\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-7\" value=\"No\" id=\"forminator-field-radio-7-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-7-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-7-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-5\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-5-6a02103cdd5d5-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-5-6a02103cdd5d5-label\" class=\"forminator-label\">Caja E - Por favor marque CUALQUIERA que aplique: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-5-1-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-5-1-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Problemas de salud conductual, mental o psicol\u00f3gicos que requieren tratamiento m\u00e9dico\/psiqui\u00e1trico.\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Problemas de salud conductual, mental o psicol\u00f3gicos que requieren tratamiento m\u00e9dico\/psiqui\u00e1trico.\" id=\"forminator-field-checkbox-5-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-5-1-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Problemas de salud conductual, mental o psicol\u00f3gicos que requieren tratamiento m\u00e9dico\/psiqui\u00e1trico.<\/span><\/label><label id=\"forminator-field-checkbox-5-2-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-5-2-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Depresi\u00f3n mayor, ideaci\u00f3n suicida, ataques de p\u00e1nico, trastorno bipolar no controlado que requiere medicaci\u00f3n\/tratamiento psiqui\u00e1trico.\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Depresi\u00f3n mayor, ideaci\u00f3n suicida, ataques de p\u00e1nico, trastorno bipolar no controlado que requiere medicaci\u00f3n\/tratamiento psiqui\u00e1trico.\" id=\"forminator-field-checkbox-5-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-5-2-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Depresi\u00f3n mayor, ideaci\u00f3n suicida, ataques de p\u00e1nico, trastorno bipolar no controlado que requiere medicaci\u00f3n\/tratamiento psiqui\u00e1trico.<\/span><\/label><label id=\"forminator-field-checkbox-5-3-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-5-3-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Haber sido diagnosticado con una condici\u00f3n de salud mental o un trastorno de aprendizaje\/desarrollo que requiere atenci\u00f3n continua o adaptaci\u00f3n especial.\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Haber sido diagnosticado con una condici\u00f3n de salud mental o un trastorno de aprendizaje\/desarrollo que requiere atenci\u00f3n continua o adaptaci\u00f3n especial.\" id=\"forminator-field-checkbox-5-3-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-5-3-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Haber sido diagnosticado con una condici\u00f3n de salud mental o un trastorno de aprendizaje\/desarrollo que requiere atenci\u00f3n continua o adaptaci\u00f3n especial.<\/span><\/label><label id=\"forminator-field-checkbox-5-4-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-5-4-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Una adicci\u00f3n a las drogas o el alcohol que requiri\u00f3 tratamiento en los \u00faltimos 5 a\u00f1os.\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Una adicci\u00f3n a las drogas o el alcohol que requiri\u00f3 tratamiento en los \u00faltimos 5 a\u00f1os.\" id=\"forminator-field-checkbox-5-4-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-5-4-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Una adicci\u00f3n a las drogas o el alcohol que requiri\u00f3 tratamiento en los \u00faltimos 5 a\u00f1os.<\/span><\/label><label id=\"forminator-field-checkbox-5-5-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-5-5-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Ninguna de las anteriores.\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Ninguna de las anteriores.\" id=\"forminator-field-checkbox-5-5-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-5-5-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ninguna de las anteriores.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-8\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-8-6a02103cdd5d5-label\" aria-describedby=\"forminator-radiogroup-radio-8-6a02103cdd5d5-description\"><span id=\"forminator-radiogroup-radio-8-6a02103cdd5d5-label\" class=\"forminator-label\">Espalda\/Hernia\/Diabetes <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-8-6a02103cdd5d5-description\" class=\"forminator-description\">He tenido problemas de espalda, hernia, \u00falceras o diabetes.<\/span><label id=\"forminator-field-radio-8-label-1\" for=\"forminator-field-radio-8-1-6a02103cdd5d5\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-8\" value=\"Si\" id=\"forminator-field-radio-8-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-8-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-8-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-8-label-2\" for=\"forminator-field-radio-8-2-6a02103cdd5d5\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-8\" value=\"No\" id=\"forminator-field-radio-8-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-8-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-8-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-6\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-6-6a02103cdd5d5-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-6-6a02103cdd5d5-label\" class=\"forminator-label\">Caja F - Por favor marque CUALQUIERA que aplique: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-6-1-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-6-1-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Problemas de espalda recurrentes en los \u00faltimos 6 meses que limitan mi actividad diaria.\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Problemas de espalda recurrentes en los \u00faltimos 6 meses que limitan mi actividad diaria.\" id=\"forminator-field-checkbox-6-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-6-1-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Problemas de espalda recurrentes en los \u00faltimos 6 meses que limitan mi actividad diaria.<\/span><\/label><label id=\"forminator-field-checkbox-6-2-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-6-2-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Cirug\u00eda de espalda o columna en los \u00faltimos 12 meses.\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Cirug\u00eda de espalda o columna en los \u00faltimos 12 meses.\" id=\"forminator-field-checkbox-6-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-6-2-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Cirug\u00eda de espalda o columna en los \u00faltimos 12 meses.<\/span><\/label><label id=\"forminator-field-checkbox-6-3-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-6-3-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Diabetes, controlada con medicamentos o dieta, O diabetes gestacional en los \u00faltimos 12 meses.\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Diabetes, controlada con medicamentos o dieta, O diabetes gestacional en los \u00faltimos 12 meses.\" id=\"forminator-field-checkbox-6-3-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-6-3-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Diabetes, controlada con medicamentos o dieta, O diabetes gestacional en los \u00faltimos 12 meses.<\/span><\/label><label id=\"forminator-field-checkbox-6-4-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-6-4-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Una hernia no corregida que limita mis capacidades f\u00edsicas.\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Una hernia no corregida que limita mis capacidades f\u00edsicas.\" id=\"forminator-field-checkbox-6-4-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-6-4-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Una hernia no corregida que limita mis capacidades f\u00edsicas.<\/span><\/label><label id=\"forminator-field-checkbox-6-5-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-6-5-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"\u00dalceras activas o no tratadas, heridas problem\u00e1ticas o cirug\u00eda de \u00falcera en los \u00faltimos 6 meses.\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"\u00dalceras activas o no tratadas, heridas problem\u00e1ticas o cirug\u00eda de \u00falcera en los \u00faltimos 6 meses.\" id=\"forminator-field-checkbox-6-5-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-6-5-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u00dalceras activas o no tratadas, heridas problem\u00e1ticas o cirug\u00eda de \u00falcera en los \u00faltimos 6 meses.<\/span><\/label><label id=\"forminator-field-checkbox-6-6-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-6-6-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Ninguna de las anteriores.\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Ninguna de las anteriores.\" id=\"forminator-field-checkbox-6-6-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-6-6-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ninguna de las anteriores.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-9\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-9-6a02103cdd5d5-label\" aria-describedby=\"forminator-radiogroup-radio-9-6a02103cdd5d5-description\"><span id=\"forminator-radiogroup-radio-9-6a02103cdd5d5-label\" class=\"forminator-label\">Est\u00f3mago\/Intestino <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-9-6a02103cdd5d5-description\" class=\"forminator-description\">He tenido problemas estomacales o intestinales, incluyendo diarrea reciente.<\/span><label id=\"forminator-field-radio-9-label-1\" for=\"forminator-field-radio-9-1-6a02103cdd5d5\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-9\" value=\"Si\" id=\"forminator-field-radio-9-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-9-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-9-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-9-label-2\" for=\"forminator-field-radio-9-2-6a02103cdd5d5\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-9\" value=\"No\" id=\"forminator-field-radio-9-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-9-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-9-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-7\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-7-6a02103cdd5d5-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-7-6a02103cdd5d5-label\" class=\"forminator-label\">Caja G - Por favor marque CUALQUIERA que aplique: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-7-1-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-7-1-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Cirug\u00eda de ostom\u00eda y no tengo autorizaci\u00f3n m\u00e9dica para nadar o realizar actividad f\u00edsica.\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Cirug\u00eda de ostom\u00eda y no tengo autorizaci\u00f3n m\u00e9dica para nadar o realizar actividad f\u00edsica.\" id=\"forminator-field-checkbox-7-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-7-1-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Cirug\u00eda de ostom\u00eda y no tengo autorizaci\u00f3n m\u00e9dica para nadar o realizar actividad f\u00edsica.<\/span><\/label><label id=\"forminator-field-checkbox-7-2-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-7-2-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Deshidrataci\u00f3n que requiri\u00f3 intervenci\u00f3n m\u00e9dica en los \u00faltimos 7 d\u00edas.\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Deshidrataci\u00f3n que requiri\u00f3 intervenci\u00f3n m\u00e9dica en los \u00faltimos 7 d\u00edas.\" id=\"forminator-field-checkbox-7-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-7-2-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Deshidrataci\u00f3n que requiri\u00f3 intervenci\u00f3n m\u00e9dica en los \u00faltimos 7 d\u00edas.<\/span><\/label><label id=\"forminator-field-checkbox-7-3-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-7-3-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"\u00dalceras estomacales o intestinales activas o no tratadas o cirug\u00eda de \u00falcera en los \u00faltimos 6 meses.\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"\u00dalceras estomacales o intestinales activas o no tratadas o cirug\u00eda de \u00falcera en los \u00faltimos 6 meses.\" id=\"forminator-field-checkbox-7-3-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-7-3-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u00dalceras estomacales o intestinales activas o no tratadas o cirug\u00eda de \u00falcera en los \u00faltimos 6 meses.<\/span><\/label><label id=\"forminator-field-checkbox-7-4-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-7-4-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Acidez estomacal frecuente, regurgitaci\u00f3n o enfermedad por reflujo gastroesof\u00e1gico (ERGE).\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Acidez estomacal frecuente, regurgitaci\u00f3n o enfermedad por reflujo gastroesof\u00e1gico (ERGE).\" id=\"forminator-field-checkbox-7-4-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-7-4-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Acidez estomacal frecuente, regurgitaci\u00f3n o enfermedad por reflujo gastroesof\u00e1gico (ERGE).<\/span><\/label><label id=\"forminator-field-checkbox-7-5-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-7-5-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Colitis ulcerosa o enfermedad de Crohn activa o no controlada.\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Colitis ulcerosa o enfermedad de Crohn activa o no controlada.\" id=\"forminator-field-checkbox-7-5-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-7-5-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Colitis ulcerosa o enfermedad de Crohn activa o no controlada.<\/span><\/label><label id=\"forminator-field-checkbox-7-6-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-7-6-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Cirug\u00eda bari\u00e1trica en los \u00faltimos 12 meses.\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Cirug\u00eda bari\u00e1trica en los \u00faltimos 12 meses.\" id=\"forminator-field-checkbox-7-6-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-7-6-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Cirug\u00eda bari\u00e1trica en los \u00faltimos 12 meses.<\/span><\/label><label id=\"forminator-field-checkbox-7-7-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-7-7-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Ninguna de las anteriores.\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Ninguna de las anteriores.\" id=\"forminator-field-checkbox-7-7-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-7-7-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ninguna de las anteriores.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-10\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-10-6a02103cdd5d5-label\" aria-describedby=\"forminator-radiogroup-radio-10-6a02103cdd5d5-description\"><span id=\"forminator-radiogroup-radio-10-6a02103cdd5d5-label\" class=\"forminator-label\">Medicamentos <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-10-6a02103cdd5d5-description\" class=\"forminator-description\">Estoy tomando medicamentos recetados (con la excepci\u00f3n de los anticonceptivos o los medicamentos antipal\u00fadicos que no sea Lariam-mefloquina).<\/span><label id=\"forminator-field-radio-10-label-1\" for=\"forminator-field-radio-10-1-6a02103cdd5d5\" class=\"forminator-radio\" title=\"Si\"><input type=\"radio\" name=\"radio-10\" value=\"Si\" id=\"forminator-field-radio-10-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-10-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-10-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-10-label-2\" for=\"forminator-field-radio-10-2-6a02103cdd5d5\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-10\" value=\"No\" id=\"forminator-field-radio-10-2-6a02103cdd5d5\" aria-labelledby=\"forminator-field-radio-10-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-10-6a02103cdd5d5-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-378573--page-3\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-378573--page-3-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"3\"\r\n\t\t\t\tdata-label=\"Historia M\u00e9dica\"\r\n\t\t\t\tdata-actual-label=\"Exoneraciones &amp; Acuerdos\"\r\n\t\t\t\tdata-name=\"\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"checkbox-8\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-8-6a02103cdd5d5-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-8-6a02103cdd5d5-label\" class=\"forminator-label\">Declaraci\u00f3n de Responsabilidades <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-8-6a02103cdd5d5-description\" class=\"forminator-description\">Por medio de este documento, afirmo que soy buceador certificado o estudiante de buceo, bajo el control y supervisi\u00f3n de instructor de SCUBA certificado y que comprendo del peligro del buceo, al ser una actividad riesgosa, adem\u00e1s de aquellos peligros que ocurren durante el viaje en lancha a motor, hacia y desde el sitio de la inmersi\u00f3n. Comprendo que estos peligros incluyen, entre otros, las lesiones por expansi\u00f3n de aire, ahogamiento, enfermedades de descomprensi\u00f3n, resbaladuras o ca\u00eddas en la lancha, recibir cortaduras o golpes por otra embarcaci\u00f3n mientras me encuentro en el agua, lesiones que ocurren al embarcar o desembarcar, y otros peligros del mar. Al firmar este acuerdo de liberaci\u00f3n de responsabilidad certifico que conozco y expresamente asumo los riesgos involucrados en la realizaci\u00f3n de dichas inmersiones, sean estas inmersiones recreativas o como parte de un curso de buceo.<\/span><label id=\"forminator-field-checkbox-8-1-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-8-1-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"S\u00ed, declaro\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"S\u00ed, declaro\" id=\"forminator-field-checkbox-8-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-8-1-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-8-6a02103cdd5d5-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">S\u00ed, declaro<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-9\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-9-6a02103cdd5d5-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-9-6a02103cdd5d5-label\" class=\"forminator-label\">Reconocimiento de Riesgos <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-9-6a02103cdd5d5-description\" class=\"forminator-description\">Al firmar este formulario, reconozco que el buceo y las actividades relacionadas implican riesgos inherentes, incluidos, entre otros: enfermedad por descompresi\u00f3n, lesiones por expansi\u00f3n de aire, ahogamiento, accidentes relacionados con embarcaciones y otros peligros relacionados con el mar.<\/span><label id=\"forminator-field-checkbox-9-1-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-9-1-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Reconozco\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Reconozco\" id=\"forminator-field-checkbox-9-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-9-1-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-9-6a02103cdd5d5-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Reconozco<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-10\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-10-6a02103cdd5d5-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-10-6a02103cdd5d5-label\" class=\"forminator-label\">Participaci\u00f3n Voluntaria <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-10-6a02103cdd5d5-description\" class=\"forminator-description\">Entiendo y acepto estos riesgos, y elijo participar de manera voluntaria.<\/span><label id=\"forminator-field-checkbox-10-1-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-10-1-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Entiendo y acepto estos riesgos\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Entiendo y acepto estos riesgos\" id=\"forminator-field-checkbox-10-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-10-1-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-10-6a02103cdd5d5-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Entiendo y acepto estos riesgos<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-11\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-11-6a02103cdd5d5-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-11-6a02103cdd5d5-label\" class=\"forminator-label\">Exoneraci\u00f3n de Responsabilidad <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-11-6a02103cdd5d5-description\" class=\"forminator-description\">Por la presente libero al Centro de Buceo Ankla Azul, sus instructores, personal y afiliados de cualquier responsabilidad por lesiones personales, da\u00f1os a la propiedad o muerte accidental que surjan de mi participaci\u00f3n en actividades de buceo, independientemente de la causa.<\/span><label id=\"forminator-field-checkbox-11-1-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-11-1-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Libero a Ankla Azul\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Libero a Ankla Azul\" id=\"forminator-field-checkbox-11-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-11-1-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-11-6a02103cdd5d5-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Libero a Ankla Azul<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-12\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-12-6a02103cdd5d5-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-12-6a02103cdd5d5-label\" class=\"forminator-label\">Objetos Personales <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-12-6a02103cdd5d5-description\" class=\"forminator-description\">Ankla Azul no se hace responsable por la p\u00e9rdida o da\u00f1o de pertenencias personales llevadas a la actividad.<\/span><label id=\"forminator-field-checkbox-12-1-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-12-1-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Acepto\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"Acepto\" id=\"forminator-field-checkbox-12-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-12-1-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-12-6a02103cdd5d5-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Acepto<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-13\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-13-6a02103cdd5d5-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-13-6a02103cdd5d5-label\" class=\"forminator-label\">Responsabilidad del equipo <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-13-6a02103cdd5d5-description\" class=\"forminator-description\">Acepto inspeccionar todo el equipo proporcionado antes de usarlo y devolverlo en buen estado, o cubrir el costo por p\u00e9rdida o da\u00f1o.<\/span><label id=\"forminator-field-checkbox-13-1-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-13-1-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Acepto\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Acepto\" id=\"forminator-field-checkbox-13-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-13-1-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-13-6a02103cdd5d5-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Acepto<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-14\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-14-6a02103cdd5d5-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-14-6a02103cdd5d5-label\" class=\"forminator-label\">Declaraci\u00f3n de Salud <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-14-6a02103cdd5d5-description\" class=\"forminator-description\">Certifico que me encuentro en buen estado f\u00edsico y mental para bucear y que no estoy bajo la influencia de drogas o alcohol. Si tengo condiciones m\u00e9dicas, he consultado a un m\u00e9dico y obtenido autorizaci\u00f3n para bucear.<\/span><label id=\"forminator-field-checkbox-14-1-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-14-1-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Declaro\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Declaro\" id=\"forminator-field-checkbox-14-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-14-1-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-14-6a02103cdd5d5-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Declaro<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-15\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-15-6a02103cdd5d5-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-15-6a02103cdd5d5-label\" class=\"forminator-label\">Compromiso del Buceador Responsable <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-15-6a02103cdd5d5-description\" class=\"forminator-description\">BUCEAR COMPETENTEMENTE: Siempre bucear dentro de mi entrenamiento y capacidades. MANTENER LA SALUD: Mantener un nivel adecuado de condici\u00f3n f\u00edsica y consciencia mental. PLAN DE BUCEO: Planear mi buceo y seguir mi plan. COMPA\u00d1ERO DE BUCEO: Permanecer con mi compa\u00f1ero desde el inicio hasta el final. INSPECCIONAR EL EQUIPO: Antes de cada inmersi\u00f3n, inspeccionar mi equipo. CONCIENCIA DEL BUCEADOR: Monitorear gas, profundidad y tiempo. RESPETAR EL ENTORNO: Ser consciente de las corrientes y la vida marina. PLANIFICAR EMERGENCIAS: Saber c\u00f3mo alertar a otros. ACEPTAR LA RESPONSABILIDAD: Soy, en \u00faltima instancia, responsable de mi propia seguridad.<\/span><label id=\"forminator-field-checkbox-15-1-6a02103cdd5d5-label\" for=\"forminator-field-checkbox-15-1-6a02103cdd5d5\" class=\"forminator-checkbox\" title=\"Me comprometo\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Me comprometo\" id=\"forminator-field-checkbox-15-1-6a02103cdd5d5\" aria-labelledby=\"forminator-field-checkbox-15-1-6a02103cdd5d5-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-15-6a02103cdd5d5-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Me comprometo<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-2\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_6a02103cdd5d5\" id=\"forminator-field-date-2-picker_6a02103cdd5d5-label\" class=\"forminator-label\">Fecha <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"11-05-2026\" placeholder=\"Elige fecha\" id=\"forminator-field-date-2-picker_6a02103cdd5d5\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"2026\" data-end-year=\"2026\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"2026-05-11\" data-end-date=\"12\/31\/2026\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"signature-1\" class=\"forminator-field-signature forminator-col forminator-col-12\"><div class=\"forminator-field forminator-field-signature\"><label for=\"forminator-field-ctlSignature6a02103ce0a95\" id=\"forminator-field-ctlSignature6a02103ce0a95-label\" class=\"forminator-label\">Firma del Participante <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-ctlSignature6a02103ce0a95-description\" class=\"forminator-description\">Declaraci\u00f3n del participante: He respondido todas las preguntas de manera honesta y entiendo que acepto la responsabilidad por cualquier consecuencia que resulte de haber respondido alguna pregunta de forma inexacta o por no haber revelado condiciones de salud existentes o pasadas.<\/span><div class=\"forminator-signature\" data-elementheight=\"180\" aria-describedby=\"forminator-field-ctlSignature6a02103ce0a95-description\"><span id=\"ctlSignature6a02103ce0a95_placeholder\" class=\"forminator-signature--placeholder\" aria-hidden=\"true\"><\/span><div id=\"ctlSignature6a02103ce0a95_Container\" class=\"forminator-signature--container\"><canvas id=\"ctlSignature6a02103ce0a95\" class=\"forminator-signature-canvas\" height=\"180\" tabindex=\"-1\"><p>Your browser does not support e-Signature field.<\/p><\/canvas><\/div><\/div><input type=\"hidden\" name=\"field-signature-1\" value=\"6a02103ce0a95\" class=\"signature-prefix\"><\/div><\/div><\/div><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>Enviar<\/button><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"aa69260145\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/es\/wp-json\/wp\/v2\/pages\/375819\" \/><input type=\"hidden\" name=\"form_id\" value=\"378573\"><input type=\"hidden\" name=\"page_id\" value=\"375819\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/anklaazul.com\/es\/liability-waiver\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><label for=\"input_35\" class=\"forminator-hidden\" aria-hidden=\"true\">Por favor, no rellenes este campo. <input id=\"input_35\" type=\"text\" name=\"input_35\" value=\"\" autocomplete=\"off\"><\/label><input type=\"hidden\" name=\"trp-form-language\" value=\"es\"\/><\/form>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_section_3 et_pb_section et_section_regular et_block_section\">\n<div class=\"et_pb_row_3 et_pb_row et_flex_row preset--module--divi-row--default\">\n<div class=\"et_pb_column_3 et_pb_column et-last-child et_grid_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone et_flex_column_24_24_phoneWide et_flex_column_24_24_tabletWide\">\n<div class=\"et_pb_text_6 et_pb_text et_pb_bg_layout_light et_pb_module et_block_module preset--module--divi-text--efokf8vg5e\"><div class=\"et_pb_text_inner\"><h2 data-path-to-node=\"3\" style=\"text-align: center;\">\u00bfNecesitas ayuda con tus formularios?<\/h2>\n<\/div><\/div>\n\n<div class=\"et_pb_text_7 et_pb_text et_pb_bg_layout_dark et_pb_module et_block_module preset--module--divi-text--3tx68shv89\"><div class=\"et_pb_text_inner\"><p data-path-to-node=\"4\" style=\"text-align: center;\">Paperwork shouldn't be the hard part of diving. Here is what we can help you with:<\/p>\n<ul data-path-to-node=\"5\">\n<li>\n<p data-path-to-node=\"5,0,0\" style=\"text-align: left;\"><b>Preguntas m\u00e9dicas:<\/b> \u00bfNo est\u00e1s seguro de c\u00f3mo responder una pregunta m\u00e9dica espec\u00edfica en el formulario?<\/p>\n<\/li>\n<li style=\"text-align: left;\">\n<p data-path-to-node=\"5,1,0\"><b>Firma Digital:<\/b> \u00bfTienes problemas para firmar el documento en tu tel\u00e9fono?<\/p>\n<\/li>\n<li>\n<p data-path-to-node=\"5,2,0\" style=\"text-align: left;\"><b>Confirmaci\u00f3n:<\/b> \u00bfQuieres verificar que recibimos tu exenci\u00f3n firmada?<\/p>\n<\/li>\n<\/ul>\n<p data-path-to-node=\"6\" style=\"text-align: center;\">If you are stuck, don't worry. Send us a message, and we\u2019ll walk you through it.<\/p>\n<p data-path-to-node=\"7\">\n<\/div><\/div>\n\n<div class=\"et_pb_module et_pb_button_module_wrapper et_pb_button_2_wrapper preset--module--divi-button--w112ovmeye_wrapper\"><a class=\"et_pb_button_2 et_pb_button et_pb_bg_layout_dark et_pb_module et_block_module preset--module--divi-button--w112ovmeye\" href=\"https:\/\/wa.me\/573112811079\" target=\"_blank\" data-icon=\"\uf232\" data-interaction-trigger=\"9w3x074d6z\">Chatea en WhatsApp<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":378589,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-375819","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/anklaazul.com\/es\/wp-json\/wp\/v2\/pages\/375819","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/anklaazul.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/anklaazul.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/anklaazul.com\/es\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/anklaazul.com\/es\/wp-json\/wp\/v2\/comments?post=375819"}],"version-history":[{"count":0,"href":"https:\/\/anklaazul.com\/es\/wp-json\/wp\/v2\/pages\/375819\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/anklaazul.com\/es\/wp-json\/wp\/v2\/media\/378589"}],"wp:attachment":[{"href":"https:\/\/anklaazul.com\/es\/wp-json\/wp\/v2\/media?parent=375819"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}