APPLICATION FORM

Name

Surname

T.C. Identification Number:

Date of birth

Phone

E-mail

City

T-shirt Size

Shoe Size

Last Graduated School

Job

Foreign Languages

Number of Children, if Any

Number of Diving Certifications, if Any

Number of Dives

Any Need for Diving Equipment?

Have you ever participated to DALSIN KIZLAR?

TO THE ATTENTION OF DIVER or DIVER CANDIDATE

When done consciously, scuba diving is a joyful recreational activity. Yet, the candidates should not have any health obstacles for this activity which has been performed under different physical conditions. Scuba diving under some health problems might lead to serious consequences and be life threatening.Questions in this document has been prepared specifically for your evaluation of own health condition. Please make sure that you read and understand every question carefully.

Have you ever had heart or blood vessel related sickness?

Have you had hearth attack?

Have you had pain in the chest, chest tightness, shortage of breath?

Do you get tired easier than the others?

Do you have fatigue complaints?

Do you have high blood pressure?

Do you have diabetes?

Are you taking any medicine?

Have you had any lung sickness (tuberculosis, pneumonia, bronchitis etc.)?

Do you have asthma?

Do you have wheezing, shortage of breath?

Have you ever had pneumothorax (collapsed lung)?

Have you ever had lung or chest surgery?

Do you frequently have colds, sinusitis?

Do you have frequent or severe attacks of hayfever or allergy?

Do you have trouble breathing through the nose?

Have you ever had ear or sinus surgery?

Do you experience ear problems during a flight or a descend from a higher altitude?

Do you have repeating ear problems?

Do you have panic attack, fear of heights or claustrophobia?

Do you have any psyciatric desease?

Have you ever had epileptic seizure?

Have you ever experienced faint, loss of consciousness?

Have you ever had a head trauma or wound which caused blackout?

Do you have back, neck or spine pain?

Have you ever had arm, leg or back problems following a trauma?

Do you have numbness in you arm, leg?

Do you have migraine recurrent headache?

Do you have dizziness?

Do you have severe suffering from motion sickness such as seasick, carsick?

Have you recently experienced excessive loss of fluid (nausea, womiting, diarhea etc.)?

Have you recently lost excessive weight loss?

Do you have any blood sickness (hemophilia, leucemia, anemia etc.)?

Have you ever had ulcer, colostomy, ileostomy surgery?

Have you had bloody defecation, bloody urine?

Have you had any surgery in last 6 months?

Do you have alcoholism or drug addiction?

Is being pregnant a probability?

Have you had decompression sickness?

Have you had any diving related sickness?

I have read the information you have issued regarding the Personal Data Protection Act. I agree to the processing of my personal data to the extent specified in the Notice.

read and agree.

TO THE ATTENTION OF DIVER or DIVER CANDIDATE

Participaton Conditions

"Dalsın Kızlar" Event Participation Conditions