Safety Number EMAIL ADDRESS: ................................................................................... Block letters please REEF EXPERIENCE ■ REEF ENCOUNTER ■ FULL NAME: ................................................................................................................................ DATE OF BIRTH: ........./......./ .................. HOME ADDRESS: ....................................................................................................................... TEL: .......................................................... Street State Country EMERGENCY ACCOMMODATION (Cairns): ................................................................................................... CONTACT ................................................. Good morning and welcome onboard Reef Experience for your tour to the outer Great Barrier Reef. If you wish to have the ultimate reef experience . ask our crew about seeing the reef at night aboard our luxury floating hotel, Reef Encounter. With its party size freshwater hot tub, fully stocked bar and chef prepared meals. Enjoy your time with us. The Queensland Government require you to fill out a Medical Questionnaire for swimming, snorkelling and scuba diving. CERTIFIED DIVERS ONLY: Certification Type ...................................................... #.......................... Date of Certification: ................................... Last Dived ........................................... Approx No. of Dives ................................ Are you Fit to Dive: ■ Yes ■ No For all Reef Experience day tour only guests who have none of the Medical Conditions listed below, we include an introductory or certified dive at the first reef location. If you enjoy your first intro or certified dive, ask our crew about another dive and cost at the second reef location. All swimmers, snorkellers and scuba divers are advised of the dangers of Jellyfish stings, Coral injuries, exhaustion, sunburn, drowning. These risks are greatly reduced by the use of neoprene wetsuits and/stinger suits (stinger season) or snorkel vests. Wetsuits/stinger suits (stinger season) save lives – please wear one. SCUBA DIVING, SNORKELLING, SWIMMING MEDICAL DECLARATION Have you suffered from, or do you now suffer from, any of the following: YES NO YES NO ■ ■ Asthma, wheezing or inhaler use ■ ■ Ear surgery ■ ■ Brain, spinal cord or nervous disorder ■ ■ Epilepsy ■ ■ Chest surgery ■ ■ Fainting, seizure or blackouts ■ ■ Chronic bronchitis or persistent chest complaint ■ ■ Heart disease of any kind ■ ■ Chronic sinus conditions (Influenza/common cold) ■ ■ Recurrent ear problems when flying ■ ■ Collapsed lung (pneumothorax) ■ ■ Tuberculosis or other long-term lung disease ■ ■ Diabetes mellitis type 1&2 (sugar diabetes) Are you currently suffering from: YES NO YES NO ■ ■ Breathlessness ■ ■ Have you ingested any alcohol within eight ■ ■ Chronic ear discharge or infection (8) hours prior to snorkelling / diving? ■ ■ High blood pressure ■ ■ Are you pregnant? ■ ■ Other illness or operation within the last month ■ ■ ■ ■ Perforated eardrum DO YOU UNDERSTAND THAT CONCEALMENT ■ ■ Are you currently taking any prescribed OF ANY CONDITION INCOMPATIBLE WITH medication/drug or any other type of SAFE SNORKELLING AND DIVING MIGHT PUT medication/drug (excluding oral YOUR LIFE OR HEALTH AT RISK? contraceptives) Do you have any other medical/health condition or issue not listed above that the crew should be made aware of? ■ YES ■ NO Please specify___________________________________________________________________________________________________________________ Are you flying within the next 12 - 24 hours? (assessed on single/multiple, diving depth and time of dive) ■ YES ■ NO Are you skydiving or hot air ballooning within the next 24 hours? ■ YES ■ NO Have you ever had a snorkelling / diving accident? ■ YES ■ NO Signature: .............................................................................................................. Date: .................................................................... Crew Member: ....................................................................................................... Doctor Consulted: .............................................. Included in the Reef Experience day tour is your choice of an introductory dive, certified dive or assisted snorkel tour at the first reef location. I would like to do: ■ Introductory diving ■ A Certified dive ■ Assisted snorkel tour (non-confident swimmers) (1st Dive Included) (1st Dive Included) ■ Guided Certified dive ■ Marine Biology Tour If you would like to participate in and know the cost of another dive at the second reef location or the cost of a guided certified dive or marine biology tour please ask a crew member. *PLEASE ENSURE YOU HAVE COMPLETED THIS FORM ACCURATELY AS YOUR SAFETY IS OUR PRIORITY* Hostel Reef Trips SNORKELLING/SWIMMING Our staff are fully trained and qualified in First Aid procedures, Rescue lifeguard techniques and CPR - Oxygen Resuscitation training. I am aware wetsuits/stinger suits (stinger season) save lives. They protect from stings and help prevent drowning. ■ I will respect the reef and not damage or stand on the coral and will not touch the marine life. ■ Snorkelling and swimming can require strenuous exertion, so for your enjoyment and safety, we recommend you always snorkel in pairs, within 100 metres of the vessel. In the unlikely event that you require assistance, a lifeguard can only be effectively implemented if you are close to the boat. If you are a poor snorkeller/swimmer, or if you are constrained by physical medical conditions, we strongly recommend supervision. A guide is available to take you on a supervised snorkel (no charge) and flotation devices are also available. We urge you to wear a wetsuit (assists with flotation and protection). If you require assistance during supervised snorkelling activities, simply wave one extended arm above your head to any of the lookouts on the boat. If you have any medical disorders, are taking any medication, or have any questions, please advise our staff when handing in this form. The following acknowledgments, representations, terms and conditions shall form part of my agreement with Hostel Reef Trips. 1. I expressly acknowledge and agree that this tour including swimming, snorkelling and diving carries with it some degree of risk both to person and property, and appreciating the risk, I accept and assume full and absolute responsibility for risk of injury or damage occasioned to myself and my property whilst participating in the aforementioned activities and tour. 2. I expressly represent to Hostel Reef Trips that: (a) I am under no legal disability or restriction with respect to my ability to freely enter into my agreement with Hostel Reef Trips; (b) I declare and confirm that I am physically fit and have no condition or injury that could be affected by swimming, snorkelling and/or diving. 3. I release, waive and hold harmless Hostel Reef Trips from all claims, losses, damages or expenses occasioned by me during or in conjunction with my participation in this tour including the water activities or otherwise incidental to my agreement with Hostel Reef Trips, including any claim or damages caused by the negligence of Hostel Reef Trips, together with any costs (including, without limitation, legal fees) that may be incurred as a result of any such claims, losses, damages, or expenses, whether valid or not. 4. I indemnify Hostel Reef Trips against all claims, losses, damages or expenses that any one or more of my executors, administrators, heirs, next of kin, successors or assigns may have or assert against Hostel Reef Trips and against any costs (including, without limitation, legal fees) that may be incurred by Hostel Reef Trips as a result of any such claim, losses, damages or expenses, whether valid or not. 5. The release and indemnity hereby given by me may be pleaded by Hostel Reef Trips as a complete and absolute defence to any claim which may be brought by me or by my executors, administrators, heirs, next of kin, successors or assigns in any country or in any jurisdiction throughout the world. 6. I hereby consent to receive medical treatment which may be deemed necessary by Hostel Reef Trips in the case of injury, accident or illness during the course of scuba diving activities or otherwise, and I hereby indemnify Hostel Reef Trips in respect of the costs of such treatment. 7. My agreement with Hostel Reef Trips shall be governed by and be construed in accordance with the laws of Queensland and the Commonwealth of Australia, and I submit myself to the jurisdiction of the Courts of Queensland and the Commonwealth of Australia. 8. The expression "Hostel Reef Trips" means Hostel Reef Trips Pty Ltd (ACN 060 804 239) which also trades under the business names "Compass Outer Reef Trips" and "Reef Encounter Enterprises", and each of its officers, employees, shareholders, contractors, agents and associates, as the circumstances may require. The expression "associates" has the meaning ascribed to it by Section 11 of Australia's Corporations Law. The singular shall mean the plural where more than one person has entered into an agreement with Hostel Reef Trips. I understand the above statement and that the information listed and questions answered are correct to the best of my knowledge. I am aware that I am visiting a World Heritage National Park, and will not intentionally harm, damage it in any way or remove anything from it. Please ask any of our friendly crew any questions you may have. Signed: ............................................................................. Date: ......................................... CHILDREN’S NAMES (under 4 years): ............................................................................... ............................................................................... Parent/Guardian signature if under 18 Years: .........................................................................