מנטה Introductory Dive - Health Decleration Date of activity* MM DD YYYYReservation name*The name given in the reservation, the same for all participants Introductory dive – health declaration form Dear diver, In order to ensure you enjoy your dive, you are kindly requested to advise us of all information pertaining to any health problem that you may have. Please note that any attempt to avoid a complete disclosure of any fact relating to your health, will remove any responsibility from us for any damage that may be caused to you as a result of the dive, and nullifies any complaint and/or claim of any kind. Are you pregnant or trying to conceive*YesNoDo you take medication on a regular basis*YesNoDo you suffer from breathing difficulties*YesNoDo you suffer from heart problems*YesNoDo you suffer from sinus problems*YesNoDo you suffer from Asthma*YesNoDo you suffer from Diabetes*YesNoDo you suffer from ear problems*YesNoDo you suffer from Claustrophobia*YesNoHave you recently had an operation or an illness*YesNoDo you suffer from any other problems*YesNoIf you answered one or more of the questions "Yes" please specify I know that it is forbidden to fly within two hours of the introductory dive. I understand that no refunds will be issued once I have started the activity and/or entered the water. I hereby confirm with my signature and declare that all the details completed by me are correct. First name*Last Name*Date of birth* MM DD YYYYAge*Parent/ guardian first name*Parent/ Guardian last name*Date: 23/02/2020Email* Publication Authorization*During the various dives and activities offered by the Manta Isrotel Diving Center, we photograph and/or film the participants for promotional purposes, and we would therefore appreciate your consent to appear in these photographs and/or video footage. 1. By signing, I authorize the Isrotel hotel chain to use all photographs and/or video footage in which I appear.2. I am aware that the Isrotel hotel chain may use the raw images and/or raw video footage for an indefinite period and in any media, including the chain's website and other promotional material.3. I am aware that the raw images and/or raw video footage taken, as well as the photographs and/or video footage produced as a result, are protected by copyright laws and are the sole property of Isrotel, and I will not take any legal or financial action whatsoever regarding such material.yes it`s okno thank youSignature*Parent/ guardian signature*(Minors)PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.