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MEDICAL HISTORY
Please answer the following questions on your past or present medical history with a YES or NO. If you are not sure answer YES.
____Do you currently have an ear infection? ____Do you have a history of colostomy?
____History of ear disease, hearing loss or problems with balance? ____History of bleeding or other blood disorders?
____Could you be pregnant or are you attempting to become pregnant? ____History of drug or alcohol abuse?
____Do you take prescription or nonprescription medications? ____Do you frequently suffer from motion sickness?
____If yes, please list all medications: _________________________ ____History of diving accidents or decompression sickness?
____Will you be flying within 18 hoursof your last dive? ____History of recurrent back problems?
Have you ever had or do you currently have… ____History of back surgery?
____Active asthma or history of emphysema or tuberculosis? ____History of diabetes?
____Respiratory problems or severe attacks of hay fever or allergy? ____History of back, arm, or leg problems following injury or fracture?
____Current/frequent colds, congestion, sinusitis, or bronchitis? ____Inability to perform moderate exercise (walk 1 mile in 12 min.)?
____Any form of lung disease? ____History of high blood pressure or take medicine to control it?
____Pneumothorax (collapsed lung)? ____History of any heart disease or angina?
____History of chest surgery? ____History of heart attacks
____Prone to panic attacks or fear of closed or open spaces? ____Angina or heart or blood vessel surgery?
____History of ear or sinus surgery? ____Over age 45 with family historyhistory of heart attacks?
____Epilepsy, seizures, convulsions or preventative medication? ____History of problems equalizing ears with airplane travel?
____History of blackouts or fainting (loss of consciousness)? ____History of any type of hernia?
____Behavioral health problems, mental or psychological or nervious system disorder?
The information I have provided about my medical history is accurate to the best of my knowledge.
_______________________________________________ _______________________________________________
SIGNATURE of PARTICIPANT SIGNATURE of PARENT or GUARDIAN
STUDENT EXAM Please circle the most correct answer once you have read the clip board provided at the shop.
1. The most dangerous animals in the water are generally:
A. Sharks B. Other large fish C. Moray eels D. Man
2. The scary underwater creatures you see on TV or in the movies are often found in the shallow water where scuba divers dive: A. True B. False
3. Due to the increase in pressure with depth, it is impossible for divers to be comfortable more than a few feet from the surface: A. True B. False
4. The best rule to remember regarding when to "clear" your ears is: A. Clear at the first sign of pain.
B. Wait until you reach the bottom before clearing. C. Begin at the surface, then clear early and often. D. Clear at increments of 10 feet.
5. What do you do if you have difficulty clearing? A. Ascend a few feet, then try again. If this doesn't work continue your decent. B. Ascend a few feet, then try again. If this doesn't work keep ascending until you can clear, then resume your descent. C. Maintain you depth until you clear. D. Continue to the bottom and clear there.
6. When breathing underwater the air in your lungs will expand on ascent, unless allowed to escape.
A. True B. False
7. The most important rule to remember while scuba diving is: A. Breathe naturally all the time, except on ascent. B. Exhale continuously on ascent. C. Breath naturally all the time… NEVER hold your breath. D. Inhale on descent, Exhale on ascent.