Medical Statement and Questionnaire

By filling out more than one box does not disqualify you from being a participant.

Medical Statement:

The purpose of this medical statement is to inform you of some potential risks involved when participating in the Commercial Diving and Industrial Inspection seminar (CDII). Participants will have opportunities to suit-up in commercial diving equipment and dive underwater in The Ocean Corporation’s diver training tanks. Participants will also have opportunities to weld and burn both on the surface and underwater. Diving and using commercial diving equipment are exciting but demanding activities. CDII participants should understand that diving and using commercial diving equipment can be strenuous and that preexisting medical conditions may affect your safety while participating.

Medical Questionnaire:

The purpose of this medical questionnaire is to identify, for both you and The Ocean Corporation, any preexisting conditions that may affect your safety while participating in CDII activities.

Please check the following selections about your medical history that apply to you.

• Each check is the same as answering YES.
• Not checking a selection is the same as answering NO.
• Only check those or any that apply to you.
• Checking a selection does not necessarily disqualify you from diving during the seminar.
• A checked response helps both you and The Ocean Corporation identify any preexisting medical conditions that could affect your safety while participating.

Please check all that apply to your medical condition

The information I have provided about my medical history is accurate to the best of my knowledge. I agree to accept responsibility for omissions or failure to disclose any existing or past health conditions.