PADI Medical Questionnaire Scuba diving is an excit ing and demand ing activity. To scuba dive you must not be extremely overwe ight or out of cond i t ion . Diving can be strenuous under certain condi t ions. Your respiratory and circulatory systems must be in g o o d health. A l l body air spaces must be normal and heal thy A person w i th heart t rouble, a current co ld or congest ion , epilepsy, asthma, a severe medical prob lem, or w h o is under the inf luence of a lcohol or drugs, should not dive. If tak ing medicat ion, consult your doctor before part ic ipat ing in this p rogram.

The purpose of the Med ica l Quest ionnaire is to f ind out if you shou ld be examined by a physician before part ic ipat ing in recreational scuba div ing. A positive response to a quest ion does not necessarily disqualify you f rom div ing. A positive response means that there is a preexisting cond i t ion that may affect your safety whi le diving and you must seek the advice of a physician.

Please answer the fo l l ow ing quest ions on your past and present medical history w i th a YES or NO. If you are not sure, answer YES. If any of these items apply to you , w e must request that you consult w i th a physician prior to part ic ipat ing in scuba div ing. Your PADI Professional wi l l supply you wi th a PADI Med ica l Statement and Guidel ines for Recreational Scuba Diver's Physical Examinat ion to take to a physic ian.

Do you currently have an ear infect ion?

Do you have a history of ear disease, hear ing loss or problems w i th balance?

Do you have a history of ear or sinus surgery?

Are you currently suffer ing f rom a co ld , congest ion , sinusitis or bronchit is?

Do you have a history of respiratory problems, severe attacks of hayfever or allergies, or

lung disease?

Have you had a col lapsed lung (pneumothorax) or history of chest surgery?

Do you have active as thma or history of emphysema or tuberculosis?

Are you currently tak ing medicat ion that carries a warn ing about any impai rment of your physical or mental abilities? Do you have behavioral heal th, menta l or psychological problems or a nervous system

disorder?

Are you or cou ld you be pregnant?

Do you have a history of co lostomy?

Do you have a history of heart disease or heart attack, heart surgery or b lood vessel surgery? Do you have a history of high b lood pressure, ang ina , or take medicat ion to control

b lood pressure?

Are you over 45 and have a family history of heart attack or stroke?

Do you have a history of b leeding or other b lood disorders? '*'' .

Do you have a history of diabetes? ',

Do you have a history of seizures, b lackouts or fa int ing, convuls ions or epilepsy or fake medicat ions to prevent them? Do you have a history of back, arm or leg problems fo l low ing an injury, fracture or surgery?

Do you have a history of fear of c losed or open spaces or panic attacks (c laustrophobia or agoraphobia )? . • .

Discover Scuba Diving Knowledge and Safety Review

To cont inue your Discover Scuba Diving experience, you must comple te this review under the direct ion of your PADI Professional BEFORE gett ing in the water.

Check the appropr iate box in response to each quest ion :

1. Upon completing this experience, I will be qualified to dive independently without a certified professional guiding me. • T D F

2. To equalize my ears and sinus air spaces during descent, I will need to blow gently against pinched nostrils. • T • F

3. I shouald equalize every metre/few feet while descending. • T • F

4. If I have discomfort in my ears or sinuses during descent, I should continue downward . • T • F

5. Underwater, I should breathe slowly, deeply, continuously and never hold my ' breath. ^ • T • F

6. I should add air to my buoyancy control device (BCD) to float at the surface. • T • F • .

7. My air gauge indicates how much air I have in my cylinder and I must look at it often, and whenever my instructor asks me to. • T • F

8. I should not touch, tease or harass an underwater organism since I may harm it or it may harm me. • T O F

9. I should stay close to the PADI Professional during my Discover Scuba Diving experience and signal if something is wrong. • T D F

Participant Statement: I have had this Review expla ined to me and I n o w understand any quest ions I may have answered incorrectly. I a cknow ledge and accept that these practices are in tended to increase my safety and comfor t dur ing the experience.

Participant Signature Date (Day/Month/Year)

Non-Agency Disclosure and Acknowledgment Agreement

I u n d e r s t a n d a n d agree t ha t PADI M e m i j ! " , c i u d i n g and/or any individual PAu i ir.s:. ..coii a C »>:>mas5efs

associated w i th the program in wh i ch I am participating, are licensed so yse various PADI Trademarks and to conduct PADI tra ining, but are not age-';" v----;. or franchisees of PADI Amer icas , Inc, or its parent, subsidiary and aff*' jns ("PADI"). I further understand that M e m b e r business activrlie: md are neither o w n e d nor operated by PADI, and that while PADI e ' -:rds for PADI diver tra ining programs, it is not responsible for, nof . " to contro l , the operat ion of the M e m b e r s ' business activitiesanci: - ,.,,, rjuct of PADI programs and supervision of divers by the Members or thew diSOCidie<J staff. I further understand and agree on behalf of myself, my heifs and my estate that in the event of an injury or death dur ing this activity, neither 1 nof my estate shall see* lohold PADI liable for the actions, inactions or negl igence of ^̂ "-̂ '̂ and/or the instructors and divemasters associated with the actnnty-

Liability Release and Assumption of Risk Agreement

I (participant name) hereby a r t . r — I aware tinat skin and scuba diving have inherent risks which may result in serious miuvf or death. I unders tand that d iv ing w i th compressed air involves certatn inherent risks; decompress ion sickness, embo l i sm or other hyperbaric tnjur«s can occur that require t reatment in a recompression chamber. I further understand that llMS program may be conduc ted at a site that is remote, either by time or distance or both, firom such a recompression chamber. I still choose to proceed w i th this program 'in spite of the absence of a recompression chamber or medical facility in proxitmy to tiye dwe site.

The in format ion I have provided about my medical history on the Medical Questioonaire is accurate to the best of my know ledge . I agree to accept responsibility for omissions regarding my failure to disclose any existing or past health conditkKK. I understand and agree that neither the dive professionals conducting this program, nor the facility th rough wh i ch this program is offered nor PADI Amer icas , Inc., nor its affi l iate or subsidiary corporaiwis, m r any of their respective employees, officers, agents or assigns (hereinafter referred Ic as "Released Parties") may be held liable or responsible in any way for any tr^ury, death or other damages to me, my family, estate, heirs or assigns that may occur as a result of my part ic ipat ion in this program or as a result of the rsegligence of ttie Reieased Parties, whe ther passive or active.

In considerat ion of being a l lowed to participate in this p rog ram, t hereby personally assume all risk's for any harm, injury or damage , whether foreseen or unrcweseen, that may befall me whi le part ic ipating in this program, including but not i m n e d to the know ledge deve lopment , conf ined water and/or open water activittes-

I further release and hold harmless the Discover Scuba Diving program and the Released Parties f rom any c la im or lawsuit by me, my family, estate, heirs or assigns, arising out of my part ic ipat ion in this p rogram.

Product No. 00703 (Rev 07/17) Version 1.03 6?AD(2017

(Liability Release a n d A s s u m p t i o n o f Risk A g r e e m e n t continued)

I further unders tand that sKin diving and scuba diving are physically strenuous activities and that I wi l l be exert ing myself dur ing this program and that if I am injured as a result of heart attack, panic , hypervent i lat ion, etc., that I expressly assume the risk of said injuries and that I wi l l not ho ld the Released Parties responsible for the same.

I further state that I am of lawful age and legally competen t to sign this Liability Release and Assumpt i on of Risk Agreement , or that I have acquired the wr i t ten consent of my parent or guardian.

I understand that the terms herein are contractual and not a mere recital and that I have s igned this Ag reemen t of my o w n free act and w i th the know ledge that I hereby agree to waive my legal rights. I further agree that if any provision of this Ag reemen t is f o u n d to be unenforceable or inval id, that provision shall be severed f rom this Agreement . The remainder o f this Agreement wi l l then be construed as though the unenforceable provision had never been conta ined herein.

I understand a n d agree that I am not only giving up my right to sue the Released Parties but also any rights my heirs, assigns or beneficiaries may have to sue the Released Parties resulting f rom my death . I further represent that I have the authority to do so and that my heirs, assigns and beneficiaries wil l be es topped f rom c la iming otherwise because of my representations to the Released Parties. I (PARTICIPANT N A M E ) BY THIS INSTRUMENT DO EXEMPT A N D RELEASE THE DIVE PROFESSIONALS C O N D U C T I N G THIS P R O G R A M , THE FACILITY T H R O U G H WH ICH THE P R O G R A M IS C O N D U C T E D , A N D PADI AMER ICAS , INC., A N D ALL RELATED ENTITIES A N D RELEASED PARTIES AS DEFINED A B O V E F R O M ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY PROPERTY D A M A G E OR W R O N G F U L DEATH, HOWEVER C A U S E D , INCLUDING BUT NOT UMITED TO THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE.

I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE A N D ASSUMPT ION OF RISK A G R E E M E N T A N D N O N - A G E N C Y DISC L05URE A C K N O W L E D G M E N T A G R E E M E N T BY READING BOTH BEFORE SIGNING BELOW O N BEHALF OF MYSELF A N D M Y HEIRS A N D AFFIRM THE MED ICAL OUESTIONNAIRE IS A C C U R A T E .

Participant Signature Date (Day/MonthA'ear)

Parent/Guafdian Signature (where applicable) Date (Day/MonthA'ear)