Skip to content
Home
About Us
Dive Trips
Courses
FAQs
Gallery
Contact us
Menu
Home
About Us
Dive Trips
Courses
FAQs
Gallery
Contact us
Gulf Divers LLC
Home
About Us
Dive Trips
Courses
FAQs
Gallery
Contact us
Menu
Home
About Us
Dive Trips
Courses
FAQs
Gallery
Contact us
Liability For Bubblemaker Course
"
*
" indicates required fields
Step
1
of
2
50%
Name
*
Birthdate
*
MM slash DD slash YYYY
Age
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Home Phone
*
Email
*
Emergency Contact
emergency contact
Relationship
Primary Phone
pp
Home
Work
Cell
Secondary Phone
sp
Home
Work
Cell
How did you hear about us?
MEDICAL QUESTIONNAIRE
To the participant and parent:
Please answer YES or NO to any of the following items to accurately reflect the participant’s past medical history or present medical condition. A YES answer to any of these items requires that a participant obtain written medical approval before being allowed to participate in scuba diving activities. If this applies, please ask for a Medical Statement (#10063) to take to the physician.
q1
*
Yes
No
I am currently suffering from a cold or congestion.
q2
*
Yes
No
I have a history of respiratory problems or disease.
q3
*
Yes
No
I have had asthma, emphysema or tuberculosis.
q4
*
Yes
No
I currently have an ear infection.
q5
*
Yes
No
I have recurrent ear problems, ear disease or surgery.
q6
*
Yes
No
I have a history of sinus problems.
q7
*
Yes
No
I have had problems equalizing (popping) my ears with airplane or mountain travel.
q8
*
Yes
No
I am diabetic.
q9
*
Yes
No
I have a history of heart condition (e.g., cardiovascular disease, angina, heart attack).
q10
*
Yes
No
I have a history of seizures, dizziness or fainting.
q11
*
Yes
No
I have a nervous system disorder.
q12
*
Yes
No
I have behavioral health, mental or psychological disorders (panic attack, fear of closed or open spaces).
q13
*
Yes
No
I have recurrent back problems, history of back or spinal surgery.
q14
*
Yes
No
I am currently taking prescription medication that carries a warning about impairment of physical and mental abilities (with the exception of anti-malarial).
q15
*
Yes
No
I have recently had an operation or illness.
q16
*
Yes
No
I am under the care of a physician or have a chronic illness.
BUBBLEMAKER ASSUMPTION OF RISK AND LIABILITY RELEASE AGREEMENT
Please read carefully and fill in all blanks before signing.
I,
name
, parent/guardian and
name
participant, hereby affirm that we are aware of and understand there are inherent hazards associated with scuba diving which may result in serious injury or death.
We understand there are certain risks associated with aquatic activities conducted in and around a swimming pool or confined water dive site, and we expressly assume the risk of said injuries.
We understand that diving with compressed air involves certain inherent risks and my child will be exposed to these risks.
Decompression sickness, embolism or other hyperbaric injuries can occur which require treatment in a recompression chamber. We further understand that this activity may be conducted at a site that is remote, either by time or distance or both, from such a recompression chamber. We still choose to proceed with this activity in spite of the absence of a recompression chamber in proximity to the activity site.
We understand and agree that neither the dive professionals conducting this activity, nor the facility through which this activity
is conducted,
store
Gulf Divers LLC ( Euro Divers Oman)
, nor International PADI, Inc., nor any of their respective
employees, officers, agents or assigns (hereinafter referred to as “Released Parties”) may be held liable or responsible in any way for any injury, death or other damages to my child, me, my family, our heirs or assigns that may occur as a result of my child’s participation in this activity or as a result of the negligence of any party, including the Released Parties, whether passive or active.
We further understand that scuba diving is a physically strenuous activity and that my child will be exerting him/herself during this activity and that if my child is injured as a result of heart attack, panic, hyperventilation, etc., that we expressly assume the risk of said injuries to my child. We affirm that we will not hold the above listed individuals or companies responsible for the same.
In consideration of my child being allowed to participate in this activity we hereby personally assume all risks in connection with the activity for any harm, injury or damage that may befall my child while participating in the activity, including all risks connected therewith, whether foreseen or unforeseen.
We further release and hold harmless said activity and the Released Parties from any claim or lawsuit by my child, me, or my family, or our estate, heirs or assigns, arising out of my child’s participation in this activity.
We understand and agree this Release is divisible, and any portion herein held to be in violation of any applicable statutes or regulations or any governmental agency having jurisdiction shall affect only that portion held to be invalid or inoperative, and the remaining portions of this Release shall remain in full force and effect.
I further state that I am of lawful age and legally competent to sign this Assumption of Risk and Liability Release Agreement, and as the parent am providing written consent for the participation of my child.
We understand that the terms herein are contractual and not a mere recital and that we have signed this Release of our own free act.
I,
text
*
, PARENT/GUARDIAN AND
text
*
PARTICIPANT, BY THIS INSTRUMENT DO EXEMPT AND RELEASE THE DIVE PROFESSIONALS CONDUCTING THIS ACTIVITY, THE FACILITY THROUGH WHICH THIS ACTIVITY IS CONDUCTED, AND INTERNATIONAL PADI, INC., AND ALL RELATED ENTITIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH, HOWEVER CAUSED, INCLUDING BUT NOT LIMITED TO THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE.
WE HAVE FULLY INFORMED OURSELVES OF THE CONTENTS OF THIS ASSUMPTION OF RISK AND LIABILITY RELEASE AGREEMENT BY READING IT BEFORE SIGNING IT ON BEHALF OF MYSELF, MY CHILD, AND OUR HEIRS.
Signature of Participant
*
Date-for-sign-participant
*
MM slash DD slash YYYY
Signature of Parent/Guardian
Date-for-signature-parent
MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.