Download the Required Paperwork for Divers
Below you can see an example of the documents you need to fill out for in-water or boat activities!
Download the required documents here, fill them out and bring them to your diving course, fun dive day or snorkelling day:
|Diving Courses||Technical Diving|
|Divemaster tools:||Instructor tools:|
Below you can see an example:
House Rules / Non-Agency Disclosure and Acknowledgment Agreement
Please read carefully and fill in all fields before signing.
This is an agreement between Chang Diving Center CO.,Ltd and
Name:__Karl Müller __
I __KM__ hereby confirm that I will abide by the CDC’s terms and conditions and house rules when using the equipment owned and provided by the facility, including CDC diving equipment.
I __KM__ take responsibility for any loss or damage that occurs.
I __KM__ agree to follow safe diving practices and environmental awareness. I will follow the instructions of the CDC dive staff, including the boat captain, when diving (the captain is responsible for the boat and passengers, so he has the final say on board, which includes choosing dive sites and cancelling trips for weather and safety reasons).
Any failure to follow safe diving practices or environmental awareness may result in the crew cancelling your dive. – In this case there is NO REFUND.
I __KM__ have read all current PRICELISTES for courses, fun dives, cancellation fees and agree to the terms and conditions.
I __KM__ also agree that if I am prevented or decide to cancel a course or activity, cancellation fees will be charged. If an activity of the next day is cancelled after 6:00 pm, a fee according to the cancellation fees will be charged.
I __KM__ understand that when I book and conduct a course, I am paying for the course, not for the certification. If the certification requirements are not met, the instructor will not certify the course.
__KM__ If for any reason I am unable to meet the performance requirements of the training agency (PADI, SDI, TDI), I have the option to continue with my training until the certification requirements are met. – An additional fee will be charged for continued training.
I __KM__ have read and understood the above points. The meaning and purpose of the rules are important to both your safety and the safety of CDC personnel.
I __KM__ understand and agree that PADI, SDI and TDI members (“Members”), including Chang Diving Center CO, LTD. and/or individual PADI, SDI and TDI Instructors and Divemasters associated with the program in which I am participating are licensed to use various PADI, SDI and TDI brands and to conduct PADI-, SDI and TDI training, but are not agents, employees or franchisees of PADI Americas Inc. , SDI, TDI, ERDI, PFI Americas or its parent, subsidiary and affiliate companies (“PADI, SDI, TDI”)
I __KM__ further understand that the business activities of Members are independent and are not owned or operated by PADI, SDI or TDI, and that while PADI, SDI or TDI sets the standards for PADI, SDI or TDI diver education programs, it is not responsible for, nor has the right to control, the operation of the business activities of Members and the daily conduct of PADI, SDI or TDI programs and the supervision of divers by Members or their associated personnel.
I __KM__ further understand and agree on behalf of myself, my heirs and my estate that in the event of injury or death during this activity, neither I nor my estate will attempt to hold PADI, SDI or TDI liable for the actions, inaction or negligence of Chang Diving Center CO., LTD. and/or the instructors and divemasters associated with the activity.
I __KM__ HAVE INFORMED ME AND MY HERITAGE COMPLETELY OF THE CONTENT OF THIS NON-AUTHORIZATIONAL DISCLOSURE AND RECOGNITION AGREEMENT, WHICH I HAVE READ, BEFORE I SIGNED IT IN MY NAME AND IN THE NAME OF MY HERITAGE.
No changes, additions, omissions or revisions may be made.
__Karl Müller __
Participant’s Signature Date
Signature of Parent or Guardian Date
General Liability Release and Express Assumption of Risk
I __Karl Müller __ , hereby affirm that I have been advised and thoroughly informed of the inherent hazards of scuba diving activities and participation in a guided tour as a diver.
__KM__ Further, I understand that diving with compressed air, oxygen enriched air (Nitrox), and trimix supplied by standard open circuit scuba or with semi-closed circuit or closed circuit rebreathers involves certain inherent risks including decompression sickness,embolism, oxygen toxicity, inert gas narcosis, hypoxia, hypercapnia, marine life injuries or other barotrauma or hyperbaric injuries.Such injuries can occur that require treatment in a recompression chamber or medical facility. I further understand that dive activities can be at remote sites, and isolated by time and distance, from such a recompression chamber or medical facility. I still choose to proceed with such dives in spite of the absence of a recompression chamber in proximity to the dive site.
__KM__ I understand and agree that neither the instructor/guide of Chang Diving Center CO.,Ltd, nor any of the respective employees, officers, agents or assigns of Chang Diving Center CO.,Ltd, (hereinafter referred to as “Released Parties”) may be held liable or responsible in any way for any injury, death, or other damages to me or my family, heirs, or assigns that may occur as a result of my participation in this diving activity or as a result of the negligence of any party, including the Released Parties, whether passive or active.
__KM__ In consideration of being allowed to participate in this activity I hereby personally assume all risks in connection with said trip, for any harm, injury, or damage that may befall me while I am a diving participant including all risks connected therewith, whether foreseen or unforeseen.
__KM__ I further agree to save, defend, indemnify, and hold harmless said Released Parties from any claim or lawsuit by me, anyone purporting to act on my behalf, my family, estate, heirs or assigns, arising directly or indirectly out of my participation and diving activities including claims arising during this activity even if such claims may be groundless, false or fraudulent.
__KM__ I also understand that diving activities are physically strenuous and that I will be exerting myself during this diving trip and that if I am injured as a result of heart attack, panic, hyperventilation, oxygen toxicity, inert gas narcosis, drowning, etc. that I expressly assume the risk of said injuries and that I will not hold the above listed individuals or companies responsible for the same, and I agree to defend, indemnify, and hold harmless said Released Parties for any such injuries incurred by me.
__KM__ I understand that these activities may place me deeper than I am able to safely execute a free ascent (without breathing gas)from.
__KM__ I understand that I may be required to furnish some of my own equipment and that I am responsible for its operating condition and maintenance.
__KM__ I understand that I may be supplied with certain items of scuba equipment and that I am responsible for reviewing its proper function and operating condition prior to using it.
__KM__ I further state that I am of lawful age and legally competent to sign this liability release, or that I have acquired the written consent of my parent or guardian.
__KM__ I further state that I am already a qualified and certified scuba diver from the following training agencies: PADI, SDI, TDI, CMAS…, and that I hold training to the level of __AOWD__. I am aware of the required certification level and/or experience necessary and recommended to enroll in this diving activity and I stipulate that I meet requirements for prior certification or equivalent experience. I have been a certified diver since __1983__ and have been diving for __37__ years for a total of __249__ dives to a maximum depth of __40__ M.
__KM__ I understand that the terms herein are contractual and not a mere recital and that I have signed this document of my own free act. Further that I understand and agree that, in the event that one or more of the provisions of this agreement, for any reason, is held by a court of competent jurisdiction to be invalid or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect any other provision hereof, and this agreement shall be construed as if such invalid, illegal or unenforceable provision or
provisions had never been contained herein.
IT IS THE INTENTION OF __Karl Müller __ BY THIS INSTRUMENT TO EXEMPT AND RELEASE MY INSTRUCTORS DIVEMASTER/GUIDE from Chang Diving Center CO., Ltd, THE BUSINESS (Chang Diving Center CO., Ltd.), AND ALL OTHER RELATED ENTITIES AND RELEASED PARTIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH HOWEVER CAUSED, OR ARISING OUT OF, DIRECTLY OR INDIRECTLY, INCLUDING, BUT NOT LIMITED TO, THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND EXPRESS ASSUMPTION OF RISK BY READING IT BEFORE SIGNING IT ON BEHALF OF MYSELF AND MY HEIRS.
No alterations, changes, omissions or revisions may be made.
__Karl Müller 20/08/2020__
Signature of Student/Participant / Date Signatures of Parents or Guardians / Date
Witness / Date
Diver Medical | Participant Questionnaire Page 1-3
Participant Name __Karl Müller__ Birthdate __20/08/2020__
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 ftness 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.
Directions Complete this questionnaire as a prerequisite to a recreational scuba diving or freediving course.
Note to women: If you are pregnant, or attempting to become pregnant, do not dive.
Directions for Medical Questionary
Complete this questionnaire as a prerequisite to a recreational scuba diving or freediving course.
Note to women: If you are pregnant, or attempting to become pregnant, do not dive..
|Question||Answer “Yes”||Answer “NO”|
|I have had problems with my lungs/breathing, heart, blood, or have been diagnosed with COVID-19.||Yes / Go to Box A||NO|
|I am over 45 years of age.||Yes / Go to Box B||NO|
|I struggle to perform moderate exercise (for example, walk 1.6 kilometer/one mile in 14 minutes or swim 200m ters/yards without resting), OR I have been unable to participate in a normal physical activity due to ftness or health reasons within the past 12 months||Yes *||NO|
|I have had problems with my eyes, ears, or nasal passages/sinuses.||Yes / Go to Box C||NO|
|I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery.||Yes *||NO|
|I have lost consciousness, had migraine headaches, seizures, stroke, signifcant head injury, or suffer from persistent neurologic injury or disease.||Yes / Go to Box D||NO|
|I am currently undergoing treatment (or have required treatment within the last fve years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning disability.||Yes / Go to Box E||NO|
|I have had back problems, hernia, ulcers, or diabetes.>||Yes / Go to Box F||NO|
|I have had stomach or intestine problems, including recent diarrhea.||Yes / Go to Box G||NO|
|I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefoquine/Lariam).||Yes *||NO|
If you answered NO to all 10 questions above, a medical evaluation is not required. Please read and agree to the participant statement below by signing and dating it.
Participant Statement: I have answered all questions honestly, and understand that I accept responsibility for any consequences resulting from any questions I may have answered inaccurately or for my failure to disclose any existing or past health conditions.
Participant Signature (or, if a minor, participant‘s parent/guardian signature required.) Date (dd/mm/yyyy)
__Karl Müller 12/01/1968__
Participant Name (Print) Birthdate (dd/mm/yyyy)
Instructor Name (Print) Facility Name (Print)
* If you answered YES to questions 3, 5 or 10 above OR to any of the questions on page 2, please read and agree to the statement above by signing and dating it AND take all three pages of this form (Participant Questionnaire and the Physician’s Evaluation Form) to your physician for a medical evaluation. Participation in a diving course
requires your physician’s approval.
Diver Medical | Participant Questionnaire Continued Page 2-3
Participant Name:__Karl Müller__Date of Birth:__12/01/1968__
|Box A – I have/have had:||Answer “Yes”||Answer “NO”|
|Chest surgery, heart surgery, heart valve surgery, stent placement, or a pneumothorax (collapsed lung).||Yes*||NO|
|Asthma, wheezing, severe allergies, hay fever or congested airways within the last 12 months that limits my physical activity/exercise.||Yes*||NO|
|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.||Yes*||NO|
|Recurrent bronchitis and currently coughing within the past 12 months, OR have been diagnosed with emphysema.||Yes*||NO||A diagnosis of COVID-19.||Yes*||NO|
|Box B – I am over 45 years of age AND:||Answer “Yes”||Answer “NO”|
|I currently smoke or inhale nicotine by other means.||Yes*||NO|
|I have a high cholesterol level.||Yes*||NO|
|I have high blood pressure.||Yes*||NO|
|I have had a close blood relative die suddenly or of cardiac disease or stroke before the age of 50, OR have a family history of heart disease before age 50 (including abnormal heart rhythms, coronary artery disease or cardiomyopathy).||Yes*||NO||A diagnosis of COVID-19.||Yes*||NO|
|Box C – I have/have had:||Answer “Yes”||Answer “NO”|
|Sinus surgery within the last 6 months.||Yes*||NO|
|Ear disease or ear surgery, hearing loss, or problems with balance.||Yes*||NO|
|Recurrent sinusitis within the past 12 months.||Yes*||NO|
|Eye surgery within the past 3 months.||Yes*||NO|
|Box D – I have/have had:||Answer “Yes”||Answer “NO”|
|Head injury with loss of consciousness within the past 5 years||Yes*||NO|
|Persistent neurologic injury or disease.||Yes*||NO|
|Recurring migraine headaches within the past 12 months, or take medications to prevent them.||Yes*||NO|
|Blackouts or fainting (full/partial loss of consciousness) within the last 5 years.||Yes*||NO|
|Epilepsy, seizures, or convulsions, OR take medications to prevent them.||Yes*||NO|
|*Physician’s medical evaluation required (see page 1)|
|Box E – I have/have had:||Answer “Yes”||Answer “NO”|
|Behavioral health, mental or psychological problems requiring medical/psychiatric treatment.||Yes*||NO|
|Major depression, suicidal ideation, panic attacks, uncontrolled bipolar disorder requiring medication/psychiatric treatment.||Yes*||NO|
|Been diagnosed with a mental health condition or a learning/developmental disorder that requires ongoing care.||Yes*||NO|
|An addiction to drugs or alcohol requiring treatment within the last 5 years.||Yes*||NO|
|Box F – I have/have had:||Answer “Yes”||Answer “NO”|
|Recurrent back problems in the last 6 months that limit my everyday activity.||Yes*||NO|
|Back or spinal surgery within the last 12 months.||Yes*||NO|
|Diabetes, either insulin- or diet-controlled, OR gestational diabetes within the last 12 months.||Yes*||NO|
|An uncorrected hernia that limits my physical abilities.||Yes*||NO|
|Active or untreated ulcers, problem wounds, or ulcer surgery within the last 6 months.||Yes*||NO|
|Box G – I have had:||Answer “Yes”||Answer “NO”|
|Ostomy surgery and do not have medical clearance to swim or engage in physical activity.||Yes*||NO|
|Dehydration requiring medical intervention within the last 7 days.||Yes*||NO|
|Active or untreated stomach or intestinal ulcers or ulcer surgery within the last 6 months.||Yes*||NO|
|Frequent heartburn, regurgitation, or gastroesophageal refux disease (GERD).||Yes*||NO|
|Active or uncontrolled ulcerative colitis or Crohn’s disease.||Yes*||NO|
|Bariatric surgery within the last 12 months.||Yes*||NO|
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