Diving Byron Bay

Booking for Discover Scuba Diving in Byron Bay

Full Name all participants

Phone

Swimming Ability

YesNo

Preferred Date

Number of People

Are all participants confident swimmers able to swim 200m unassisted?

YesNo

Medical Questionaire: Medical Questionnaire for TRY SCUBA DIVING. Please read carefully through the following 11 medical questions. Please be aware that if you tick yes to any of the questions you will need to get a dive medical to go diving. A dive medical will need to be shown to the Instructor on the day. Please note if you tick NO on this form and on the day you tick YES to the same or similar question, we will be to take you diving and be unable to credit, refund or reschedule your booking. Do ANY PARTICIPANTS in this booking suffer from or have they in the past suffered from any of the following conditions:

I am over 45 years of age

YesNo

Lung / Breathing / Heart and Blood: Have I had problems with my lungs, breathing, heart and/or blood affecting my normal physical or mental performance?

YesNo

Exercise and Fitness: Do you struggle to perform moderate exercise OR have been unable to participate in normal physical activity due to fitness or health reasons.

YesNo

Eyes / Ears / Sinuses:Do you have problems with your eyes, ears, or nasal passages/sinuses.

YesNo

Surgeries in the last 12 months: Have you had surgery within the last 12 months, OR have ongoing problems related to a past surgery?

YesNo

Head Injuries / Neurological Issues: Have you ever lost consciousness, had migraine, seizures, stroke, significant head injury or suffer from persistent neurological injury or disease?

YesNo

Behavioral / Psychological / Nervous Issues: Do you have a history of psychological problems, personality disorder, panic attacks, addiction to drugs or alcohol or learning/development disability

YesNo

Back Problems / Hernia / Ulcers or Diabetes:Do you have a history of back problems, hernia, ulcers or diabetes?

YesNo

Stomach or Intestinal Problems:Do you have stomach or intestinal problems including recent diarrhea?

YesNo

Prescription Medication: Are you taking any prescription medication (with the exception of birth control or anti-malarial drugs other than mefloquine (larium).

YesNo

Are any of the persons in this booking pregnant?

YesNo

Is anyone in this booking under 12 years old?

YesNo

Is anyone in this booking over 65 years old?

YesNo

E-Learning: To participate in the Try SCUBA experience there is a PADI online e-learning component (approx 30 mins) and medical waiver that needs to be completed BEFORE check-in at Diving Byron bay. The link to these will be emailed to you once booking is complete. We recommend completing these in plenty of time so if there are any issues you have time to get clearance.

E-learning and medical waiver and medical waiver I understand that there is a medical waiver and e-learning component that needs to be completed before arrival.

YesNo

SIZING RESTRICTION:: I affirm that everyone in this booking is under 118kg and can fit into one of the provided wetsuits or, alternatively will provide their own.

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Total to Pay $ AUD

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