SayPro Medical and Registration Form Template: 5-Day Diving Camp.

Objective:
The SayPro Medical and Registration Form is designed to collect essential personal information, medical history, and consent from participants of the 5-Day Diving Camp. This form ensures that the camp staff has a comprehensive understanding of each participant’s health and medical history, allowing for a safe and tailored diving experience. The form also includes consent sections, ensuring legal permission for participation and acknowledgment of potential risks associated with scuba diving.

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Participant Registration Information

1. Full Name:
   (First Name, Last Name)
2. Date of Birth:
   (MM/DD/YYYY)
3. Gender:
   ☐ Male ☐ Female ☐ Other: _______________ ☐ Prefer not to answer
4. Phone Number:
   (Home/Cell)
5. Email Address:
6. Emergency Contact Information:
   • Name of Emergency Contact:
   • Relationship to Participant:
   • Emergency Contact Phone Number:
7. Home Address:
   (Street, City, State, ZIP Code)

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Section 1: Medical History

Please answer the following questions regarding your medical history. This information is essential to ensure your safety during the camp.

1. Do you have any pre-existing medical conditions that may affect your ability to participate in scuba diving?
   (e.g., asthma, heart conditions, epilepsy, etc.)
   ☐ Yes ☐ No
   If yes, please list the condition(s) and provide details:
2. Do you have a history of any of the following?
   (Check all that apply)
   ☐ Asthma
   ☐ Heart Conditions
   ☐ Diabetes
   ☐ Seizures/Epilepsy
   ☐ Dizziness or Fainting
   ☐ Ear Problems or Surgery
   ☐ Lung Problems
   ☐ Recent Surgery or Injury
   ☐ Other (Please specify): _____________________________
3. Are you currently taking any medication?
   ☐ Yes ☐ No
   If yes, please list the medications and dosage:
4. Do you have any known allergies?
   ☐ Yes ☐ No
   If yes, please list them:
5. Have you ever experienced any issues with scuba diving, such as difficulty equalizing, dizziness, or any other related issues?
   ☐ Yes ☐ No
   If yes, please provide details:
6. Do you wear corrective lenses (glasses or contact lenses)?
   ☐ Yes ☐ No
   If yes, please check the appropriate option:
   ☐ Glasses ☐ Contact Lenses
7. Do you have any other medical concerns that may require attention during the camp?
   ☐ Yes ☐ No
   If yes, please provide details:

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Section 2: Diving Experience

1. Have you participated in scuba diving before?
   ☐ Yes ☐ No
2. If yes, how many dives have you completed?
3. Are you currently a certified diver?
   ☐ Yes ☐ No
   If yes, please provide details about your certification:
4. What type of diving certification do you hold (if applicable)?
   ☐ Open Water Diver ☐ Advanced Open Water Diver ☐ Rescue Diver ☐ Master Diver ☐ Other: ________________
5. Do you have any prior scuba diving training?
   ☐ Yes ☐ No
   If yes, please specify the type of training:

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Section 3: Consent and Acknowledgment

1. Medical Consent:
   I acknowledge that the information provided on this form is accurate to the best of my knowledge. I agree to notify the camp staff of any changes to my medical condition or medications before or during the course of the camp.
   ☐ I agree
2. Release of Liability and Waiver:
   I, the undersigned, fully understand and acknowledge that scuba diving is an inherently dangerous activity. By participating in the 5-Day Diving Camp, I voluntarily assume all risks associated with scuba diving, including but not limited to personal injury, property damage, or death. I release SayPro, its staff, instructors, and agents from any and all liability associated with my participation in the camp, including but not limited to any injuries or accidents that may occur.
   ☐ I agree
3. Emergency Medical Treatment Consent:
   In case of an emergency, I authorize the camp staff and its agents to seek appropriate medical treatment for me, including transportation to a medical facility, if necessary. I understand that I will be responsible for any medical expenses incurred due to an emergency while attending the camp.
   ☐ I agree
4. Photography and Media Consent:
   I consent to the use of photographs, videos, and other media taken during the diving camp for promotional purposes by SayPro, including use on websites, social media, and marketing materials.
   ☐ I agree ☐ I do not agree
5. Participant’s Declaration:
   I certify that I am physically fit to participate in the 5-Day Diving Camp and have disclosed all relevant medical information to ensure my safety. I understand that I must follow all safety protocols and guidelines outlined by the camp staff and instructors.
   ☐ I agree

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Participant’s Signature

By signing below, I acknowledge that I have read and understood all the information provided in this registration and medical form. I consent to participate in the SayPro 5-Day Diving Camp and accept the terms and conditions outlined above.

Participant’s Signature:

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Date:

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Parent/Guardian Consent (If Under 18)

If the participant is under the age of 18, a parent or guardian must sign this consent form.

Parent/Guardian Name:

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Relationship to Participant:

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Parent/Guardian Signature:

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Date:

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Camp Coordinator Use Only:

• Medical Review Completed by:
• Date of Review:
• Notes/Additional Actions (If Applicable):

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Conclusion:
The SayPro Medical and Registration Form is a critical tool for ensuring the safety and well-being of all participants during the 5-Day Diving Camp. By collecting detailed personal and medical information and securing the necessary consent forms, the camp is able to provide a safe and enjoyable diving experience tailored to each participant’s health and ability.