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Health Declaration

To participate in club activities we need an up-to-date health declaration. Renew your declaration every six months here. Please read carefully before filling out. 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 medical conditions. This statement has been developed to make you aware of these conditions. The purpose of a medical statement is to find out if you should be examined by a doctor before participating in any Freediving activity events. Please read each question carefully and answer them accurately. Please explain any “yes” answer. A positive answer will not necessarily exclude you from participating in any Kimberley Freediving Club endorsed events / training competitions, but it will require a medical clearance from a physician. This form and your answers will be kept confidential.  Conditions of relevance include:

I will declare if I have any of the conditions 1- 12 above, and before participating in Club activities I will disclose any negative change or occurrence of these conditions. I will obtain a medical fitness to dive certificate if I have any of these conditions. 

Thanks for submitting!

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