Fun Diving Participation Agreement

★Full Name (Required)★

★Date of Birth★

★Gender★
MaleFemale

★Address★

★Phone Number★

★Email Address (Required)★

★Reservation Dates★
　～　

★Lead Guest Name★

【Emergency Contact】
★Full Name (Required)★

★Phone Number (Required)★

★Relationship (Required)★

◆Rental Equipment◆
If you require rental equipment, please check the appropriate items and provide the requested information.

★Height★

★Weight★

★Shoe Size (Please round up to the nearest 0.5 cm)★

★Uncorrected Vision (Only if you require prescription lenses)★

MaskSnorkel

BootsFinsGloves

RegulatorBCD

WetsuitDrysuit

Full Rental (Wetsuit)Full Rental (Drysuit)

Surface Marker Buoy (SMB) ※
※All divers in Izu Oshima are required to carry a Surface Marker Buoy (SMB) during every dive. If you do not have one, please be sure to rent one from us.

★Diving Information★

1. Please tell us your certification agency and certification level. (Required)

2. Approximately how many logged dives do you have? (Required)

3. When was your most recent dive? (Required)
Within 1 Month3 Months Ago6 Months Ago10 Months Ago1 Year AgoMore Than 1 Year Ago

4. What is the deepest dive you have completed? (Required)
Up to 12mUp to 18mUp to 25mUp to 30mDeeper than 30m

5. What is your average air consumption rate (L/min)?

6. Do you have experience with boat diving? (Required)
YesNo

7. Do you have experience with night diving? (Required)
YesNo

8. How confident are you with buoyancy control? (Required)
Very ConfidentAverageNot Confident

9. Do you own a dive computer? (Required)
YesNo

10. Do you have any problems that commonly occur while diving? (Required)
NoneDifficulty Equalizing EarsProne to SeasicknessDizzinessOther

Please describe the problem.

11. Do you have any preferred dive sites?
Guide's RecommendationAki-no-HamaNodahamaKeikaiOhnohama

12. What type of diving would you like to enjoy on this trip?
Guide's RecommendationUnderwater PhotographyMarine Life ObservationRelaxed Fun Dive

◆Liability Waiver◆

If sea conditions, my physical condition, or any other circumstances make diving unsafe for me, I will cancel my dive.

I confirm that I am currently in good health and have no medical condition that would prevent me from diving.

I will handle the scuba tank with appropriate care.

While participating in boat diving, I will follow all instructions given by the captain and instructor and act responsibly.

I am participating in this guided dive of my own free will and acknowledge that, as a certified diver, I am responsible for my own safety.

I accept all risks associated with scuba diving and agree not to make any legal claims or seek compensation from the guide or other participants unless the incident was caused by intentional misconduct or gross negligence.

I understand and agree to the above terms in consideration of my own safety and the safety of others during this diving trip.

Please read the waiver carefully and sign below.

★Date (Required)★

★Signature (Required)★

★Parent/Guardian Name★

Please check all items that apply. If you are unsure about any of the questions, please contact us before making a reservation.

I am currently under a doctor's advice not to participate in normal physical exercise.

I am currently receiving medical treatment or taking prescription medication.

I have a history of epilepsy, dizziness, or fainting.

I have a history of diabetes (including insulin treatment).

I am being treated for high blood pressure.

I have a heart condition (including angina, heart attack, or other heart or vascular diseases).

I have a respiratory condition (such as asthma, bronchitis, emphysema, pneumothorax, tuberculosis, COVID-19, etc.).

I am currently pregnant.

I have claustrophobia.

I have ear problems (such as outer ear infection, middle ear infection, inner ear disorder, etc.).

I experience ear problems when flying.

I am prone to motion sickness (boat or car).

I have allergies.

I wear glasses or contact lenses.

I wear dentures.

I am not feeling well today (cold symptoms, lack of sleep, fatigue, excessive alcohol consumption, etc.).

I have concerns about this diving trip.

Δ