Merak Diving | Diver Registration

1Personal details

2Activity

3Medical questionnaire

4Terms & signature

DNI, NIE, CIF,Passport*

Name and surname*
*

Birth date*

Telephone*
*

Email*
*

Language

Country*

What activity are you going to do?.

Dive Try scuba diving Open Water Course ADV Course Specialty Course

To have your equipment ready when you arrive, tell us:

Height (cm)*

Weight (kg)*

Shoe size*

Diver certification*

Certifying agency*

Certification ID*

Number of dives*

Date of the last dive?*

Do you need insurance?*
Days from the date of contracting the insurance.

Insurance carrier*

Expiration Insurance*

Tank*

Do you need diving equipment?*

To get your gear ready for your arrival, please let us know what you need, along with your height, weight, and shoe size.

Mask Fins Booties Wetsuit BCD Regulator Dive computer

*Divers are obliged (by regulations) to dive with a computer. This is for security. If you don't have your own, you can rent it at Merak Diving.

Image of the degree (opctional)

Contact and Telephone Emergencies.*

Take the Medical surveyI have a Medical Certificate

Attach Medical Certificate

Diver Medical | Participant Questionnaire

Recreational scuba diving and freediving requires good physical and mental health.There are a few medical conditions which can be hazardous while diving, listed below.Those who have, or are predisposed to, any of these conditions, should be evaluated by a physician.This Diver Medical Participant Questionnaire provides a basis to determine if you should seek out that evaluation.If you have any concerns about your diving fitness not represented on this form, consult with your physician before diving.If you are feeling ill, avoid diving.If you think you may have a contagious disease, protect yourself and others by not participating in dive training and/ or dive activities.References to "diving" on this form encompass both recreational scuba diving and freediving.This form is principally designed as an initial medical screen for new divers, but is also appropriate for divers taking continuing education.For your safety, and that of others who may dive with you, answer all questions honestly.

Complete this questionnaire as a prerequisite to a recreational scuba diving or freediving course.

Note to women: If you are pregnant, or attempting to become pregnant, do not dive.

Answer all questions YES or NO

0/10

I have had problems with my lungs, breathing, heart and/or blood affecting my normal physical or mental performance.

YES NO

Chest surgery, heart surgery, heart valve surgery, an implantable medical device (eg, stent, pacemaker, neurostimulator), pneumothorax, and/or chronic lung disease.

YES NO

Asthma, wheezing, severe allergies, hay fever or congested airways within the last 12 months that limits my physical activity/exercise.

YES NO

A problem or illness involving my heart such as: angina, chest pain on exertion, heart failure, immersion pulmonary edema, heart attack or stroke, OR am taking medication for any heart condition.

YES NO

Recurrent bronchitis and currently coughing within the past 12 months, OR have been diagnosed with emphysema.

YES NO

Symptoms affecting my lungs, breathing, heart and/or blood in the last 30 days that impair my physical or mental performance.

YES NO

I am over 45 years of age.

YES NO

I currently smoke or inhale nicotine by other means.

YES NO

I have a high cholesterol level.

YES NO

I have high blood pressure.

YES NO

I have had a close blood relative die suddenly or of cardiac disease or stroke before the age of 50, OR have a family history of heart disease before age 50 (including abnormal heart rhythms, coronary artery disease or cardiomyopathy).

YES NO

I struggle to perform moderate exercise (for example, walk 1.6 kilometer/one mile in 14 minutes or swim 200 meters/yards without resting), OR I have been unable to participate in a normal physical activity due to fitness or health reasons within the past 12 months.

YES* NO

I have had problems with my eyes, ears, or nasal passages/sinuses.

YES NO

Sinus surgery within the last 6 months.

YES NO

Ear disease or ear surgery, hearing loss, or problems with balance.

YES NO

Recurrent sinusitis within the past 12 months.

YES NO

Eye surgery within the past 3 months.

YES NO

I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery.

YES* NO

I have lost consciousness, had migraine headaches, seizures, stroke, significant head injury, or suffer from persistent neurologic injury or disease.

YES NO

Head injury with loss of consciousness within the past 5 years.

YES NO

Persistent neurologic injury or disease.

YES NO

Recurring migraine headaches within the past 12 months, or take medications to prevent them.

YES NO

Blackouts or fainting (full/partial loss of consciousness) within the last 5 years.

YES NO

Epilepsy, seizures, or convulsions, OR take medications to prevent them.

YES NO

I am currently undergoing treatment (or have required treatment within the last five years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning or developmental disability.

YES NO

Behavioral health, mental or psychological problems requiring medical/psychiatric treatment.

YES NO

Major depression, suicidal ideation, panic attacks, uncontrolled bipolar disorder requiring medication/psychiatric treatment.

YES NO

Been diagnosed with a mental health condition or a learning/developmental disorder that requires ongoing care or special accommodation.

YES NO

An addiction to drugs or alcohol requiring treatment within the last 5 years.

YES NO

I have had back problems, hernia, ulcers, or diabetes.

YES NO

Recurrent back problems in the last 6 months that limit my everyday activity.

YES NO

Back or spinal surgery within the last 12 months.

YES NO

Diabetes, either drug or diet controlled, OR gestational diabetes within the last 12 months.

YES NO

An uncorrected hernia that limits my physical abilities.

YES NO

Active or untreated ulcers, problem wounds, or ulcer surgery within the last 6 months.

YES NO

I have had stomach or intestine problems, including recent diarrhea.

YES NO

Ostomy surgery and do not have medical clearance to swim or engage in physical activity.

YES NO

Dehydration requiring medical intervention within the last 7 days.

YES NO

Active or untreated stomach or intestinal ulcers or ulcer surgery within the last 6 months.

YES NO

Frequent heartburn, regurgitation, or gastroesophageal reflux disease (GERD).

YES NO

Active or uncontrolled ulcerative colitis or Crohn’s disease.

YES NO

Bariatric surgery within the last 12 months.

YES NO

I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefloquine (Lariam).

YES* NO

Fecha de la versión: 01-02-2026 SSI

If you answered NO to the 10 previous questions, is not required a medical evaluation. Please, read and accept the following participant statement with the date and your signature.

Participant statement: I answered all the questions honestly and I understand that I accept the responsibility for any consequence resulting from any question that I could have answered inaccurately or any current or past health condition that I didn’t reveal.

Signature of the participant (or if the person is a minor, it’s required the signature of the participant’s parent/guardian).

Name of parent/guardian in case of minor

Sign Close

Date 09/09/2026

Instructor: Xavier Boqué Arguemí. Dive Center: Merak Diving

* If you answered YES to the previous questions 3, 5 or 10 or any of the questions of the page 2, read and accept the previous statement with the date and signature and bring the Medical Evaluation form to your doctor for a medical evaluation. The participation in a diving program requires the evaluation and approval of your doctor.

I accept the conditions
I accept the Privacy Policy

ACCEPTANCE AND CONSENT TREATMENT OF IMAGESO

The right to one's own image is recognized by article 18 of the constitution and regulated by Law 1/1982, of May 5, on the right to honor and self-image, Law 15/1999, of December 13, on Protection of Personal Data.Merak Yacht Charter S.L. asks for consent to be able to publish the images in which they appear individually or in groups, taken at school or during practices.

I consent

I don't consent

The User declares to have been informed of the conditions on protection of personal data, accepting and consenting to the automated treatment thereof by MERAK CHARTER S.L in the manner and for the purposes indicated in this Personal Data Protection Policy.Through this Privacy Policy we inform you that the photographs that are posted on the web or on the social networks of Merak Diving, Merak Charter or Merak Escuela Náutica are the property of MERAK CHARTER SL, including those of minors, in which, To obtain these, the prior consent of the parents, guardians or legal representatives has been obtained by accepting this form. However, the parents, guardians or representatives of the minors, as holders of the exercise of their rights, and always after a formal written request, may indicate the refusal to use the image of the minor; in this case, the image will appear pixelated or it will not be published.