Health Self‑Assessment Form

Before booking, every participant must review the following preliminary health checklist based on past and current medical conditions.
If you answer “YES” or are unsure about any item, please download and complete the Medical Questionnaire and obtain a physician’s signature.

❗ Preliminary Health Checklist (Pay Attention if ANY Answer is “YES”)

• Are you pregnant or possibly pregnant? (Pregnant individuals cannot join any activity or boat trip.)
• Do you have any lung, respiratory, cardiac, circulatory, or blood-related problems?
• Are you over 45 years of age?
• Do you have difficulty performing moderate physical exertion (e.g., briskly walking 1.6 km / 1 mile in 14 minutes, or swimming 200 m)?
• Have you been unable to engage in normal physical activity at any time in the past 12 months due to a health issue?
• Do you have disorders or after‑effects involving the eyes, ears, nose, or sinuses?
• Have you had surgery within the past 12 months or still have after‑effects from any surgery?
• History of loss of consciousness, migraine, epilepsy/seizures, stroke, serious head injury, or neurological disorder?
• Have you received treatment for psychological issues, personality disorders, drug or alcohol dependence (including within the past 5 years)?
• Learning or developmental disorders?
• Back problems, hernia, ulcer, or diabetes?
• Recent gastrointestinal issues (e.g., diarrhea)?
• Are you currently taking any prescription medication (other than birth control or anti‑malarials)?

📌 If You Answer “YES” to Any Item:

• Please inform us at the time of booking and have a physician evaluate your fitness to participate.
• On the activity day you must provide the original or digital copy of the Medical Questionnaire signed by a physician.
• RiShima Dive reserves the final right to approve or deny participation based on safety considerations.

📝 Submission Procedure

1. Step 1: Download the Medical Questionnaire (3 pages) and fill in your personal information and signature.
2. Step 2: Bring the form to a medical facility; have a licensed physician evaluate and sign it.
3. Step 3: Before the activity date, email the completed form to rishimadive@gmail.com or send it via LINE / Instagram / RED (Xiaohongshu).

RiShima Dive reserves the final right to permit, modify, suspend, or terminate participation in any activity. Official announcements on the RiShima Dive website take precedence.