ࡱ> VXUa *(jbjbA]A] F+?+? 8Dh$,d:h   9999999,<R?9! o   9+:+++ 9+&$J6 9++i1F>9 8$94:0d:8?+?H9+$ DTHALASSA DIVE CENTER Registration Form Guest Name: ....................................................................... .. Date of Birth: ..... Home Country: .............................................E-mail: ......................................... Passport Number: ....................... Staying at Hotel: ............................................................Room number: ....................Check out date :......................... Which diving license do you have? .....(Divers only) How many dives have you already made? ... When did you make your last dive? ...... Please read carefully, fill in your name and sign the below stated 2 forms: I hereby acknowledge that I have been advised and thoroughly informed of the inherent risks of skin and scuba diving. In particular, I acknowledge that I have been advised and understand: That diving with compressed air involves certain inherent risks of decompression sickness, embolism and other hyperbaric injuries and that such injuries may result in death or serious disablement. That injuries of the type referred in the point above may require treatment in a recompression chamber. That open water diving trips which are necessary for training and for certification may be conducted at a site that is remote either and/or distance form a recompression chamber. ( Manado has a recompression chamber, but logistics usually require extended travel time) That skin diving and scuba diving are physically demanding activities and in susceptible individuals may cause heart attack, panic or hyperventilation. That scuba diving involves the use of equipment that may malfunction giving rise to risk of death or disablement. That skin diving and scuba diving necessarily involve exposure to the natural elements including but without limiting the generally hereof storm, tempest, wind, tides and marine life. Such exposure brings with it attendant risk of death or disablement. I further acknowledge that prior to commencing my course, snorkel or dive trip with THALASSA DIVE CENTER and her employees, I have completed the attached medical statement detailing my medical history. and that I have been advised of the risks associated with skin diving and scuba diving, I wish to undertake the course or dive trip with DIVE CENTER THALASSA and her employees and hereby release and hold harmless DIVE CENTER THALASSA and her employees from any suit, demand or claim arising as a consequence of death or injury received by me during my participation in the said course or trip. I further acknowledge that this document may be relied upon in any proceedings instituted in any court by me or my heirs, executors and assigns. I also hereby formally declare that I am not, and have never been subject to any of the following: Asthma or wheezing Brain, spinal cord or nervous disorder Chest surgery Chronic bronchitis or persistent chest complaint Chronic sinus conditions Collapsed lung (pneumothorax) Diabetes mellitus (sugar diabetes) Epilepsy Fainting, seizures or blackouts Heart disease of any kind Recurrent ear problems when flying Tuberculosis or other long term disease Decompression sickness Ear surgery I further declare that I am not currently subject to any of following: Breathlessness Ear discharge or infection High blood pressure Other illness or operation within the last one month Perforated eardrum and that: I am not currently taking any prescribed medicine or drug (excluding oral contraceptives). I have not ingested any alcohol within eight (8) hours prior to diving. I am not pregnant (delete if inapplicable). I understand that concealment of any condition incompatible with safe diving might put my life of health in risk. I also understand that I should not go to altitude (fly) within 18 hours of completing a single dive or 24 hours for multiple dives (where possible, wait 24 hours). SIGNATURE ...................................................... STANDARD SAFE DIVING PRACTICES, ENVIRONMENTAL PROTECTION STATEMENT OF UNDERSTANDING & COMPANY REGULATIONS This is a statement which reminds you of the established safe diving practice for skin and scuba diving as well as the regulations connected to the environmental protection of this area Your signature on this statement is required as proof that you are aware of this safe diving practices. Read and discuss the statement prior to signing it. If you are a minor, a parent or guardian must also sign this form. I understand that as a diver I should: Maintain good mental and physical fitness for diving. Avoid being under the influence of alcohol or dangerous drugs when diving. Keep proficient in diving skills, striving to increase them through continuing education and reviewing them in controlled conditions after a period of diving inactivity. Be familiar with my dive sites. If not, obtain a formal diving orientation form knowledgeable, local sources. If diving conditions are worse than those in which I am experienced, postpone diving or select an alternative site with better conditions. Engage only in diving activities consistent with my training and experience. I agree always to dive with a dive guide, assigned by any Dive Center. Use complete, well maintained, reliable equipment with which I am familiar, and inspect it for correct fit and function prior to each dive. Deny use of my equipment to uncertified divers. Always have a buoyancy control device and submersible pressure gauge, an alternate air source and a low-pressure buoyancy control inflation system when scuba diving. Listen carefully to dive briefings and directions and respect the advice of those supervising my diving activities and adhere to the buddy system throughout every dive. Plan dives - including communications, procedures for returning in case of separation, and emergency procedures - with my buddy. Be proficient in dive-table and/or dive computer usage. Make all dives no-decompression dives and allow a margin of safety. Have a means to monitor depth and time under water. Limit maximum depth to my level of training and experience, but in no circumstance dive deeper than 40 meters (120 feet). Ascend at a rate of maximum 18 meters (60 feet) per minute. Maintain proper buoyancy. Adjust weighting at the surface for neutral buoyancy with no air in my buoyancy control device. Maintain neutral buoyancy while under water. Be buoyant for surface swimming and resting. Have weight clear for easy removal, and establish buoyancy when in distress while diving. Breathe properly for diving, never breath hold or skip breathe when breathing compressed air, and avoid excessive hyperventilation when breath hold diving. Avoid overexertion while in and under water and dive within my limitation. Know and obey local diving laws and regulations, including fish - and - game and - flag laws. I am also aware that I will be diving in a sensitive eco-system. In order to minimize my impact on the marine environment: I will not touch any marine organism or their habitat and will not wear gloves; I will be aware of my underwater movements and equipment at all times so as to avoid contact with the reef; If I take pictures I will not manually manipulate marine life in order to compose my photograph nor will I instruct my buddy or dive guide to do so. I agree to act in an environmentally responsible manner unless in an emergency situation where I must act to protect myself or others from danger. If I observe anyone violating these rules, I will immediately report this to a dive guide or the management. In accordance with the North Sulawesi Watersports Association charter, I understand that I can be excluded from further diving activities if I ignore this statement, with no right to a refund. In repeat cases or if I display a blatant disregard for the marine environment I understand that my name and a report of my environmentally-damaging activities will be shared with other dive centers. Name: ............... Name of parent or legal guardian.................... Signature: .............Signature of parent or legal guardian: .............. Date: ......................Pre-dive briefing by: Rate: .....................Witnessing Instructor: .............................. 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