“For the Love of Nature: No Pepper, Please! Fill Out the Online FormPlease read carefully and fill in all blanks before signing.First Name *Last Name *Date Of Birth *Phone *Email Address *Select *Choose if you are certified or notI am a certified diverI am not a certified diverFirst Name *Last Name *Phone *Email Address *RELEASE OF LIABILITY AGREEMENTAcknowledgment of Risks 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 Other sea-related hazards I understand and accept these risks, and I choose to participate voluntarily. Release of Liability I hereby release Ankla Azul Diving Center, its instructors, staff, and affiliates from any liability for personal injury, property damage, or wrongful death arising from my participation in diving activities, regardless of cause. Equipment Responsibility I agree to: Inspect all provided equipment before use. Return equipment in good condition or cover the cost of loss or damage. Health Declaration I certify that I am in good physical and mental health for diving and not under the influence of drugs or alcohol. If I have medical conditions, I have consulted a physician and obtained clearance to dive. Personal Belongings Ankla Azul is not responsible for loss or damage to personal belongings brought to the activity. Accessibility and Privacy Notice This form complies with accessibility standards. If you have questions or require assistance, contact us. Your personal information is securely stored and used solely for participation purposes.Yes, I declare *Through this document, I declare that I am a certified diver or a diving student under the control andsupervision of a certified diving professional. I affirm that I understand that diving is considered a high-riskactivity and its inherent hazards may result in serious injuries or death. Additionally, I understand andaccept the risks associated with the motorboat trip to and from the dive site. I understand that thesedangers include, but are not limited to, air expansion injuries, drowning, decompression sickness, slipsor falls on the boat, cuts or injuries from another boat while I am in the water, injuries occurringwhile boarding or disembarking, and other sea-related risks. By signing this release of liabilityagreement, 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.I acknowledge *Acknowledgment of Risks By signing this form, I acknowledge that scuba diving and related activities involve inherent risks, including but not limited to:Decompression sicknessAir expansion injuriesDrowningBoat-related accidentsOther sea-related hazardsI understand and accept these risks *I understand and accept these risks, and I choose to participate voluntarily.Release of Liability I hereby release Ankla Azul Diving Center, its instructors, staff, and affiliates from any liability for personal injury, property damage, or wrongful death arising from my participation in diving activities, regardless of cause.I understand and accept these risks *I understand and accept these risks, and I choose to participate voluntarily.Release of Liability I hereby release Ankla Azul Diving Center, its instructors, staff, and affiliates from any liability for personal injury, property damage, or wrongful death arising from my participation in diving activities, regardless of cause.I accept *Personal Belongings Ankla Azul is not responsible for loss or damage to personal belongings brought to the activity.I agree *Equipment Responsibility I agree to:Inspect all provided equipment before use.Return equipment in good condition or cover the cost of loss or damage.I certify *Health Declaration I certify that I am in good physical and mental health for diving and not under the influence of drugs or alcohol. If I have medical conditions, I have consulted a physician and obtained clearance to dive.Recreational scuba diving and freediving requires good physical and mental health. There are a few medical conditions which can be hazardous while diving, listed below. Those who have, or are predisposed to, any of these conditions, should be evaluated by a physician. This Diver Medical Participant Questionnaire provides a basis to determine if you should seek out that evaluation. If you have any concerns about your diving fitness not represented on this form, consult with your physician before diving. If you are feeling ill, avoid diving. If you think you may have a contagious disease, protect yourself and others by not participating in dive training and/or dive activities. References to “diving” on this form encompass both recreational scuba diving and freediving. This form is principally designed as an initial medical screen for new divers, but is also appropriate for divers taking continuing education. For your safety, and that of others who may dive with you, answer all questions honestly.I have had problems with my lungs/breathing, heart, blood, or have been diagnosed with COVID-19. *YesNoI am over 45 years of age. *YesNoI struggle to perform moderate exercise (for example, walk 1.6 kilometer/one mile in 14 minutes or swim 200 meters/yards without resting), OR I have been unable to participate in a normal physical activity due to fitness or health reasons within the past 12 months. *YesNoI have had problems with my eyes, ears, or nasal passages/sinuses *YesNoI have had surgery within the last 12 months, OR I have ongoing problems related to past surgery. *YesNoI have lost consciousness, had migraine headaches, seizures, stroke, significant head injury, or suffer from persistent neurologic injury or disease. *YesNoI am currently undergoing treatment (or have required treatment within the last five years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning disability *YesNohave had back problems, hernia, ulcers, or diabetes. *YesNoI have had stomach or intestine problems, including recent diarrhea *YesNoI am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefloquine/Lariam). *YesNoConsent *Participant Statement: I have answered all questions honestly, and understand that I accept responsibility for anyconsequences resulting from any questions I may have answered inaccurately or for my failure to disclose any existing orpast health conditions.Signature *Start signing your signature hereYour browser does not support e-Signature field.Consent *Scuba diving is an adventure activity that requires the use of specialized life support equipment in an underwater environment where humanscould not otherwise exist. As with other adventure activities, scuba diving has elements of risk that cannot be totally eliminated regardless ofthe amount of training, care, caution or expertise. SSI believes these risks may be reduced through the SSI Diver Diamond – development ofproper Knowledge, Skills, Equipment and Experience. Ultimately it is up to each individual diver to assume the inherent risk associated withscuba diving and each diver’s responsibility to minimize the risk through exercising good judgment, common sense, respect and personalawareness during all diving activities. SSI has developed a Responsible Diver Code to remind divers of your responsibilities for each dive.As a Responsible Diver – I pledge to:DIVE COMPETENTLY – Always dive within my training, certification, experience, comfort and ability.MAINTAIN APPROPRIATE DIVER HEALTH – Including appropriate fitness, physical health and mental awareness to dive.UTILIZE A DIVE PLAN – Plan my dive and dive my plan. Listen to and follow dive briefings.BE A RESPONSIBLE DIVE PARTNER – Remain with my dive partner from start to finish of my dive. Know our plan toreunite if separated underwater.INSPECT MY DIVE EQUIPMENT – Before each dive, I will inspect my equipment and make sure everything is workingproperly. I will confirm my cylinder valve is completely open. When using blended gas (i.e., Enriched Air Nitrox) – I shallanalyze my gas and know its limitations. I will establish proper weighting, know how to release my weights, and verifymy buoyancy compensator (BC) and inflator are connected and functioning properly. I will secure my submersiblepressure/depth gauge and/or dive computer where it is easily accessible, and know how to use each.DIVER AWARENESS – Monitor my cylinder pressure; making sure to surface with reserve gas and never run out of gas.Monitor my depth and time, respect no decompression limits, perform controlled ascents, safety stops, and monitor mydive partner.MAINTAIN PROFICIENT SCUBA SKILLS – I understand scuba skills and knowledge are perishable. If it has been morethan six months since my last dive, I understand the importance of taking a Scuba Skills Update course. I will maintainproper buoyancy throughout my dive, ascend slowly, and breathe properly to avoid overexpansion injuries.RESPECT THE ENVIRONMENT – Be aware of currents, waves, visibility, temperature, weather, boat traffic, slippery,uneven and unstable surfaces, overhead environments, entanglements, and hazardous marine life. I understand boatsare unsteady surfaces and will always use one hand to stabilize myself. I understand the importance of taking anorientation dive with a local professional when diving in unfamiliar environments. I will obey all diving and applicableregulations, statutes and codes.PLAN FOR EMERGENCIES – In addition to inspecting all of my dive equipment, I will verify my dive partner’s equipmentis functioning properly, configured appropriately and that I know how to remove our weights in case of an emergency.I will make sure our alternate air sources are properly secured and easily accessible in case of a low air or out of airemergency. I will know scuba hand signals and how to alert others in case of an emergency. I will have an emergencyaction plan in case my dive partner or I have an emergency.ACCEPT RESPONSIBILITY – I am ultimately responsible for my safety during all diving activities. Failure to complywith these responsibilities will increase my risk of serious injury or death. Accidents can happen even when all safetyguidelines are followed, therefore I should obtain personal dive accident insurance.Send MessagePor favor, no rellenes este campo.
