Diver Activities Consent Form

Capture informed consent from participants before a diving activity, recording their medical history and prior experience.

Use this template

Full name

First Name

Last Name

Date of birth

Address

Street Address

City

State / Province

ZIP / Postal Code

Email

Phone number

Emergency contact name

First Name

Last Name

Emergency contact phone number

Medical conditions or allergies (if any)

Do you have any previous diving experience?

Yes No

If yes, please provide details

Do you have a valid diving certification?

Yes No

If yes, please provide certification details

Have you completed a medical examination within the last 12 months?

Yes No

If yes, please provide the date of the examination

Have you ever had a diving-related injury or incident?

Yes No

If yes, please provide details

Related templates