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Diving medicine / Diving equipment / Decompression / Scuba diving / Assumption of risk / Recreational diving / Diving chamber / Professional Association of Diving Instructors / Risk / Underwater diving / Underwater sports / Water


Bubblemaker/Jr. Diver Statement Participant Record (confidential information) PLEASE PRINT CLEARLY.   Name _______________________________________________________ Birthdate _____________ Age _______ Address _________
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Document Date: 2013-04-24 05:58:21

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File Size: 1,23 MB

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Company

Rainbow Aquatics Inc. / International PADI Inc. / /

Holiday

Assumption / /

IndustryTerm

care of a physician or have a chronic illness / confined water dive site / mountain travel / activity site / /

MedicalCondition

serious injury / injury / embolism / FOR PERSONAL INJURY / heart attack / ear disease / disease / seizures / fainting / nervous system disorder / angina / psychological disorders / Decompression sickness / hyperbaric injuries / hyperventilation / panic attack / emphysema / dizziness / illness / chronic illness / ear infection / cardiovascular disease / injuries / tuberculosis / asthma / /

MedicalTreatment

back surgery / surgery / spinal surgery / /

Person

Charlie Dolfun Scuba / /

Position

physician / Bubblemaker/Jr. Diver / /

Technology

cellular telephone / /

SocialTag