FREEDIVING

How did you find Pranamaya?*
WebsiteTrip AdvisorDive CenterFriends
What activities did you book with us?*

Do you have a Freediving Certification?*

If Yes, please specify the organization name and the date of your last dive:

Personal records

FREEDIVING EQUIPMENT

Do you need freediving equipement?*
MaskSnorkelWeightbeltWetsuitFins

Wetsuit size*:

Fins size (EU)*:

LIABILITY AND ASSUMPTION OF RISK

I, , hereby declare that I am aware that freediving has inherent risks, which may result in serious injury or death. I still choose to participate in the freediving activities with Pranamaya Freediving.

I understand and agree that neither my instructor Julien Borde, nor any of the Pranamaya Staff nor AIDA International, nor any of their respective employees, officers, agents, contractors or assigns (herein after referred to as the “Released Parties”) may be held liable or responsible in any way for any injury, death, or other damages to me, my family, estate, heirs, or assigns that may occur as a result of my participation in freediving activity with AIDA International or as a result of the negligence of any party, including the Released Parties whether passive or active.

In consideration of AIDA International allowing me to participate in the freediving activity, I hereby personally assume all risks of the experience, whether foreseen or unforeseen, that may befall me while I am freediving with Pranamaya Freediving.

I declare that I am in good mental and physical fitness for freediving and that I am not under the influence of alcohol, nor am I under the influence of any drugs that are contraindicatory to freediving. I declare that if requested as a result of completion of the AIDA Medical Statement, I have seen a physician and have approval to freedive.

I further declare that I am of lawful age and legally competent to sign this liability release. I understand the terms herein are contractual and not a mere recital, and that I have signed this document of my own free act and with the knowledge that I hereby agree to waive my legal rights. I further agree that if any provision of this Agreement is found to be unenforceable or invalid that provision shall be severed from this Agreement. The remainder of this Agreement will then be construed as though the unenforceable provision had never been contained therein.

I confirm that I have read this release of liability and assumption of risk agreement in its entirety and have agreed to the terms freely and voluntarily.
Freediver First Name:*

Freediver Last Name:*

Date of the day:*

AIDA MEDICAL STATEMENT

Freediving is a strenuous activity carried out in the underwater environment, which may, under certain conditions, increase your risk of injury. This risk may be significantly increased if you have certain physical conditions. These same physical conditions would not necessarily be a safety factor in other strenuous activities or sports. AIDA, therefore, uses the following questionnaire to make you aware of these conditions. Failure to address these conditions prior to engaging in breath-hold diving activity may endanger your health, your safety, and the safety of any person you may dive with in the future.

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in freedive training. A positive response to a question does not necessarily disqualify you from freediving. A positive response means that there is a pre-existing condition that may affect your safety while freediving, and you MUST seek the advice of a physician before engaging in freedive activities. If you answer "yes" to any of the following questions, you will be required to provide a medical certificate signed by your physician prior to the commencement of the courses.

- Mental and Mood Conditions:* Current or history of mental illness or mood disorder including, but not limited to schizophrenia, paranoid disorder, bouts of hysteria.

- Neurological Conditions:* Including, but not limited to any history of seizure disorder, stroke, brain surgery, repeated blackouts or fainting fits, severe migraine headaches, or aneurysm of the brain’s blood vessels.

- Cardiovascular Conditions:* Including, but not limited to heart attack, heart surgery, irregular heartbeat, pacemaker, uncontrolled elevated blood pressure.

- Pulmonary Conditions:* Including, but not limited to asthma, history of spontaneous collapsed lung, collapsed lung due to injury, cysts or air pockets of the lungs, severe damage to lung tissue, emphysema, any lung problem which interferes with your ability to breathe.

- Ear, nose and throat Conditions:* Including, but not limited to tumor, polyps, or cyst of the sinus cavities or nasal passages, major sinus surgery, persistent sinus infection, permanent holes of the eardrums, history of ruptured eardrum, permanent tubes in ear-drums, severely impaired hearing or hearing loss in one or both ears, major ear surgery.

- Eye Condition:* Including, but not limited to severe myopia, retinal detachment, eye surgery.

- Diabetes Mellitus:* Type I Diabetes (Insulin dependent) or Type II Diabetes, which requires Insulin or oral medication for control. Any form of Diabetes that is unstable, “brittle” or produces episodes of hypoglycemia (low blood sugar reactions), hyperglycemia (extremely high blood sugar with ketosis) or if there is related kidney disease, eye disease, heart disease or blood vessel disease.

- Freediving/Scuba Diving History:* Including, but not limited to previous history of a diving accident, severe blackout, decompression sickness, decompression of the inner ear of air, reverse block, lung squeeze, any lung squeeze producing pink foam, pulmonary bleeding.

- General Medical Problems:* Any physical and/or emotional condition not mentioned that might affect your safety in an underwater environment or affect your judgment under times of physical or emotional stress.

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