Please fill in this form before your first dive: once for the group, then one part per diver.
1. Contact person
Emergency contact
2. Your stay in Moorea
Free transfers: pick-up from your accommodation if you stay between the Linareva hotel (Haapiti) and the Hilton (Papetoai), for two consecutive dives or a whale-watching trip. Outside this area, meet us at the centre, on Les Tipaniers beach.
⚠️ Before flying, allow some time after your last dive: 12 hours for a domestic flight, 24 hours for an international flight. You can, however, dive as soon as you arrive.
3. Additional information
Diver 1
You and diving
PDF, JPG, PNG — 1 MB maximum.
More than a year without diving: a refresher dive will normally be required before exploration dives.
Health information
Making sure you dive safely. Since your medical certificate of fitness to dive, or over the last 12 months, please answer the questions below. If you are not sure, tick YES.
Have you had chest pain, palpitations, unusual shortness of breath or felt faint during exercise?
Has a member of your family died suddenly of an unexplained cardiac cause?
Have you had an episode of wheezing or loss of consciousness?
Have you had a decompression accident, and/or hyperbaric chamber sessions following it?
N/A
Do you have bone, muscle or joint pain or disorders?
Have you gone back to diving after more than 4 weeks off for medical reasons, without seeing a doctor?
N/A
Have you had surgery this year (heart, neurological, lung)?
Have you recently started a new regular prescribed treatment (other than contraception)?
Do you have a medical history or medical problems that could make diving inadvisable?
You answered YES at least once: see a doctor and bring a medical certificate of fitness to dive (no contraindication to underwater activities) before diving. A medical certificate is only valid for 3 months.
From the age of 65 (on your arrival date), a medical certificate of fitness to dive is required in addition to this questionnaire, whatever your answers. A medical certificate is only valid for 3 months.
You answered NO to all questions: you can dive by signing the statement below.
