{"id":256,"date":"2024-06-28T20:34:38","date_gmt":"2024-06-28T16:34:38","guid":{"rendered":"https:\/\/captain-mimis-diving-center.com\/?page_id=256"},"modified":"2025-01-17T14:20:42","modified_gmt":"2025-01-17T10:20:42","slug":"information-and-medical","status":"publish","type":"page","link":"https:\/\/captain-mimis-diving-center.com\/fr\/information-and-medical\/","title":{"rendered":"Personal Information and Medical"},"content":{"rendered":"<p>This is a statement in which you are informed of some potential risks involved in recreational scuba diving and of the conduct required of you during the recreational scuba training. Please ensure you read all sections carefully.<\/p>\n\n\n\n<p><br>You must complete this Medical Statement, which includes the medical-history information section, to enrol in the recreational scuba-training programme.<\/p>\n\n\n\n<p><br>The purpose of this medical information sheet is to inform you whether you should be examined by a physician before participating in recreational diving training. If any of these conditions apply to you this does not necessarily disqualify you from recreational scuba diving. It only means that you must seek the advice of a physician.<\/p>\n\n\n\n<p><\/p>\n\n\n<p><div class=\"forminator-ui forminator-custom-form forminator-custom-form-254 forminator-design--flat  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-254\" data-uid=\"69eb8d7746dee\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-254\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-254 forminator-design--flat  forminator_ajax\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"254\"\r\n\t\t\t\tenctype=\"multipart\/form-data\" data-color-option=\"default\" data-design=\"flat\" data-grid=\"open\" style=\"display: none;\"\r\n\t\t\t\tdata-uid=\"69eb8d7746dee\" action=\"\"\r\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div role=\"tablist\" class=\"forminator-pagination-steps\" aria-label=\"Pagination\"><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-254--page-0\"\r\n\t\t\t\tclass=\"forminator-pagination forminator-pagination-start\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-254--page-0-label\"\r\n\t\t\t\tdata-step=\"0\"\r\n\t\t\t\tdata-label=\"Liability &amp; Contact\"\r\n\t\t\t\tdata-actual-label=\"Personal Information\"\r\n\t\t\t\tdata-name=\"page-break-1\"\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_69eb8d7746dee\" id=\"forminator-field-name-1_69eb8d7746dee-label\" class=\"forminator-label\">Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-1_69eb8d7746dee\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69eb8d7746dee\" id=\"forminator-field-email-1_69eb8d7746dee-label\" class=\"forminator-label\">Email Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"E.g. john@doe.com\" id=\"forminator-field-email-1_69eb8d7746dee\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-2\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_69eb8d7746dee\" id=\"forminator-field-date-2-picker_69eb8d7746dee-label\" class=\"forminator-label\">Date of Birth <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-2-picker_69eb8d7746dee\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69eb8d7746dee\" id=\"forminator-field-phone-1_69eb8d7746dee-label\" class=\"forminator-label\">Phone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"E.g. +1 300 400 5000\" id=\"forminator-field-phone-1_69eb8d7746dee\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12\"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_69eb8d7746dee\" id=\"forminator-field-address-1-street_address_69eb8d7746dee-label\" class=\"forminator-label\">Street Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"E.g. 42 Wallaby Way\" id=\"forminator-field-address-1-street_address_69eb8d7746dee\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1-address_line\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-address_line_69eb8d7746dee\" id=\"forminator-field-address-1-address_line_69eb8d7746dee-label\" class=\"forminator-label\">Apartment, suite, etc<\/label><input type=\"text\" name=\"address-1-address_line\" placeholder=\"\" id=\"forminator-field-address-1-address_line_69eb8d7746dee\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-line2\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_69eb8d7746dee\" id=\"forminator-field-address-1-city_69eb8d7746dee-label\" class=\"forminator-label\">City <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"E.g. Sydney\" id=\"forminator-field-address-1-city_69eb8d7746dee\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-level2\" value=\"\" \/><\/div><\/div><div id=\"address-1-state\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-state_69eb8d7746dee\" id=\"forminator-field-address-1-state_69eb8d7746dee-label\" class=\"forminator-label\">State\/Province<\/label><input type=\"text\" name=\"address-1-state\" placeholder=\"E.g. New South Wales\" id=\"forminator-field-address-1-state_69eb8d7746dee\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-level1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_69eb8d7746dee\" id=\"forminator-field-address-1-zip_69eb8d7746dee-label\" class=\"forminator-label\">ZIP \/ Postal Code<\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"E.g. 2000\" id=\"forminator-field-address-1-zip_69eb8d7746dee\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><div id=\"address-1-country\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-254__field--address-1-country_69eb8d7746dee\" id=\"forminator-field-254__field--address-1-country_69eb8d7746dee-label\" class=\"forminator-label\">Country <span class=\"forminator-required\">*<\/span><\/label><select name=\"address-1-country\" id=\"forminator-field-254__field--address-1-country_69eb8d7746dee\" class=\"forminator-select2\" data-search=\"true\" data-placeholder=\"S\u00e9lectionner un pays\" autocomplete=\"country-name country\" data-default-value=\"\"><option value=\"\" data-country-code=\"\" selected=\"selected\"><\/option><option value=\"Afghanistan\" data-country-code=\"AF\" >Afghanistan<\/option><option value=\"Afrique du Sud\" data-country-code=\"ZA\" >Afrique du Sud<\/option><option value=\"Albanie\" data-country-code=\"AL\" >Albanie<\/option><option value=\"Alg\u00e9rie\" data-country-code=\"DZ\" >Alg\u00e9rie<\/option><option value=\"Allemagne\" data-country-code=\"DE\" >Allemagne<\/option><option value=\"Andorre\" data-country-code=\"AD\" >Andorre<\/option><option value=\"Angola\" data-country-code=\"AO\" >Angola<\/option><option value=\"Anguilla\" data-country-code=\"AI\" >Anguilla<\/option><option value=\"Antarctique\" data-country-code=\"AQ\" >Antarctique<\/option><option value=\"Antigua-et-Barbuda\" data-country-code=\"AG\" >Antigua-et-Barbuda<\/option><option value=\"Antilles N\u00e9erlandaises\" data-country-code=\"AN\" >Antilles N\u00e9erlandaises<\/option><option value=\"Apatrides\" data-country-code=\"XX\" >Apatrides<\/option><option value=\"Arabie Saoudite\" data-country-code=\"SA\" >Arabie Saoudite<\/option><option value=\"Argentine\" data-country-code=\"AR\" >Argentine<\/option><option value=\"Arm\u00e9nie\" data-country-code=\"AM\" >Arm\u00e9nie<\/option><option value=\"Aruba\" data-country-code=\"AW\" >Aruba<\/option><option value=\"Australie\" data-country-code=\"AU\" >Australie<\/option><option value=\"Autriche\" data-country-code=\"AT\" >Autriche<\/option><option value=\"Azerba\u00efdjan\" data-country-code=\"AZ\" >Azerba\u00efdjan<\/option><option value=\"Bahamas\" data-country-code=\"BS\" >Bahamas<\/option><option value=\"Bahre\u00efn\" data-country-code=\"BH\" >Bahre\u00efn<\/option><option value=\"Bangladesh\" data-country-code=\"BD\" >Bangladesh<\/option><option value=\"Belgique\" data-country-code=\"BE\" >Belgique<\/option><option value=\"Bermudes\" data-country-code=\"BM\" >Bermudes<\/option><option value=\"Bhoutan\" data-country-code=\"BT\" >Bhoutan<\/option><option value=\"Bi\u00e9lorussie\" data-country-code=\"BY\" >Bi\u00e9lorussie<\/option><option value=\"Bolivie\" data-country-code=\"BO\" >Bolivie<\/option><option value=\"Bosnie-Herz\u00e9govine\" data-country-code=\"BA\" >Bosnie-Herz\u00e9govine<\/option><option value=\"Botswana\" data-country-code=\"BW\" >Botswana<\/option><option value=\"Brunei\" data-country-code=\"BN\" >Brunei<\/option><option value=\"Br\u00e9sil\" data-country-code=\"BR\" >Br\u00e9sil<\/option><option value=\"Bulgarie\" data-country-code=\"BG\" >Bulgarie<\/option><option value=\"Burkina Faso\" data-country-code=\"BF\" >Burkina Faso<\/option><option value=\"Burundi\" data-country-code=\"BI\" >Burundi<\/option><option value=\"B\u00e9lize\" data-country-code=\"BZ\" >B\u00e9lize<\/option><option value=\"B\u00e9nin\" data-country-code=\"BJ\" >B\u00e9nin<\/option><option value=\"Cambodge\" data-country-code=\"KH\" >Cambodge<\/option><option value=\"Cameroun\" data-country-code=\"CM\" >Cameroun<\/option><option value=\"Canada\" data-country-code=\"CA\" >Canada<\/option><option value=\"Cap Vert\" data-country-code=\"CV\" >Cap Vert<\/option><option value=\"Chili\" data-country-code=\"CL\" >Chili<\/option><option value=\"Chine, R\u00e9publique populaire de\" data-country-code=\"CN\" >Chine, R\u00e9publique populaire de<\/option><option value=\"Chypre\" data-country-code=\"CY\" >Chypre<\/option><option value=\"Cit\u00e9 du Vatican\" data-country-code=\"VA\" >Cit\u00e9 du Vatican<\/option><option value=\"Colombie\" data-country-code=\"CO\" >Colombie<\/option><option value=\"Comores\" data-country-code=\"KM\" >Comores<\/option><option value=\"Congo, R\u00e9publique du\" data-country-code=\"CG\" >Congo, R\u00e9publique du<\/option><option value=\"Congo, R\u00e9publique d\u00e9mocratique du\" data-country-code=\"CD\" >Congo, R\u00e9publique d\u00e9mocratique du<\/option><option value=\"Cor\u00e9e, R\u00e9publique de\" data-country-code=\"KR\" >Cor\u00e9e, R\u00e9publique de<\/option><option value=\"Cor\u00e9e, R\u00e9publique d\u00e9mocratique populaire de\" data-country-code=\"KP\" >Cor\u00e9e, R\u00e9publique d\u00e9mocratique populaire de<\/option><option value=\"Costa Rica\" data-country-code=\"CR\" >Costa Rica<\/option><option value=\"Croatie\" data-country-code=\"HR\" >Croatie<\/option><option value=\"Cuba\" data-country-code=\"CU\" >Cuba<\/option><option value=\"Cura\u00e7ao\" data-country-code=\"CW\" >Cura\u00e7ao<\/option><option value=\"C\u00f4te d\u2019Ivoire\" data-country-code=\"CI\" >C\u00f4te d\u2019Ivoire<\/option><option value=\"Danemark\" data-country-code=\"DK\" >Danemark<\/option><option value=\"Djibouti\" data-country-code=\"DJ\" >Djibouti<\/option><option value=\"Dominique\" data-country-code=\"DM\" >Dominique<\/option><option value=\"Espagne\" data-country-code=\"ES\" >Espagne<\/option><option value=\"Estonie\" data-country-code=\"EE\" >Estonie<\/option><option value=\"Fidji\" data-country-code=\"FJ\" >Fidji<\/option><option value=\"Finlande\" data-country-code=\"FI\" >Finlande<\/option><option value=\"France\" data-country-code=\"FR\" >France<\/option><option value=\"France, M\u00e9tropolitaine\" data-country-code=\"FX\" >France, M\u00e9tropolitaine<\/option><option value=\"Gabon\" data-country-code=\"GA\" >Gabon<\/option><option value=\"Gambie\" data-country-code=\"GM\" >Gambie<\/option><option value=\"Ghana\" data-country-code=\"GH\" >Ghana<\/option><option value=\"Gibraltar\" data-country-code=\"GI\" >Gibraltar<\/option><option value=\"Grenade\" data-country-code=\"GD\" >Grenade<\/option><option value=\"Groenland\" data-country-code=\"GL\" >Groenland<\/option><option value=\"Gr\u00e8ce\" data-country-code=\"GR\" >Gr\u00e8ce<\/option><option value=\"Guadeloupe\" data-country-code=\"GP\" >Guadeloupe<\/option><option value=\"Guam\" data-country-code=\"GU\" >Guam<\/option><option value=\"Guat\u00e9mala\" data-country-code=\"GT\" >Guat\u00e9mala<\/option><option value=\"Guernesey\" data-country-code=\"GG\" >Guernesey<\/option><option value=\"Guin\u00e9e\" data-country-code=\"GN\" >Guin\u00e9e<\/option><option value=\"Guin\u00e9e \u00c9quatoriale\" data-country-code=\"GQ\" >Guin\u00e9e \u00c9quatoriale<\/option><option value=\"Guin\u00e9e-Bissau\" data-country-code=\"GW\" >Guin\u00e9e-Bissau<\/option><option value=\"Guyane\" data-country-code=\"GY\" >Guyane<\/option><option value=\"Guyane fran\u00e7aise\" data-country-code=\"GF\" >Guyane fran\u00e7aise<\/option><option value=\"G\u00e9orgie\" data-country-code=\"GE\" >G\u00e9orgie<\/option><option value=\"G\u00e9orgie du Sud et Sandwich du Sud\" data-country-code=\"GS\" >G\u00e9orgie du Sud et Sandwich du Sud<\/option><option value=\"Ha\u00efti\" data-country-code=\"HT\" >Ha\u00efti<\/option><option value=\"Honduras\" data-country-code=\"HN\" >Honduras<\/option><option value=\"Hong Kong\" data-country-code=\"HK\" >Hong Kong<\/option><option value=\"Hongrie\" data-country-code=\"HU\" >Hongrie<\/option><option value=\"Inde\" data-country-code=\"IN\" >Inde<\/option><option value=\"Indon\u00e9sie\" data-country-code=\"ID\" >Indon\u00e9sie<\/option><option value=\"Iran\" data-country-code=\"IR\" >Iran<\/option><option value=\"Iraq\" data-country-code=\"IQ\" >Iraq<\/option><option value=\"Ireland\" data-country-code=\"IE\" >Ireland<\/option><option value=\"Islande\" data-country-code=\"IS\" >Islande<\/option><option value=\"Israel\" data-country-code=\"IL\" >Israel<\/option><option value=\"Italie\" data-country-code=\"IT\" >Italie<\/option><option value=\"Jama\u00efque\" data-country-code=\"JM\" >Jama\u00efque<\/option><option value=\"Japon\" data-country-code=\"JP\" >Japon<\/option><option value=\"Jersey\" data-country-code=\"JE\" >Jersey<\/option><option value=\"Jordanie\" data-country-code=\"JO\" >Jordanie<\/option><option value=\"Kazakhstan\" data-country-code=\"KZ\" >Kazakhstan<\/option><option value=\"Kenya\" data-country-code=\"KE\" >Kenya<\/option><option value=\"Kirghizistan\" data-country-code=\"KG\" >Kirghizistan<\/option><option value=\"Kiribati\" data-country-code=\"KI\" >Kiribati<\/option><option value=\"Kosovo\" data-country-code=\"XK\" >Kosovo<\/option><option value=\"Kowe\u00eft\" data-country-code=\"KW\" >Kowe\u00eft<\/option><option value=\"La Barbade\" data-country-code=\"BB\" >La Barbade<\/option><option value=\"Lesotho\" data-country-code=\"LS\" >Lesotho<\/option><option value=\"Lettonie\" data-country-code=\"LV\" >Lettonie<\/option><option value=\"Liban\" data-country-code=\"LB\" >Liban<\/option><option value=\"Libye\" data-country-code=\"LY\" >Libye<\/option><option value=\"Lib\u00e9ria\" data-country-code=\"LR\" >Lib\u00e9ria<\/option><option value=\"Liechtenstein\" data-country-code=\"LI\" >Liechtenstein<\/option><option value=\"Lithuanie\" data-country-code=\"LT\" >Lithuanie<\/option><option value=\"Luxembourg\" data-country-code=\"LU\" >Luxembourg<\/option><option value=\"Macao\" data-country-code=\"MO\" >Macao<\/option><option value=\"Mac\u00e9doine du Nord\" data-country-code=\"MK\" >Mac\u00e9doine du Nord<\/option><option value=\"Madagascar\" data-country-code=\"MG\" >Madagascar<\/option><option value=\"Malaisie\" data-country-code=\"MY\" >Malaisie<\/option><option value=\"Malawi\" data-country-code=\"MW\" >Malawi<\/option><option value=\"Maldives\" data-country-code=\"MV\" >Maldives<\/option><option value=\"Mali\" data-country-code=\"ML\" >Mali<\/option><option value=\"Malte\" data-country-code=\"MT\" >Malte<\/option><option value=\"Maroc\" data-country-code=\"MA\" >Maroc<\/option><option value=\"Martinique\" data-country-code=\"MQ\" >Martinique<\/option><option value=\"Mauritanie\" data-country-code=\"MR\" >Mauritanie<\/option><option value=\"Mayotte\" data-country-code=\"YT\" >Mayotte<\/option><option value=\"Mexique\" data-country-code=\"MX\" >Mexique<\/option><option value=\"Micron\u00e9sie\" data-country-code=\"FM\" >Micron\u00e9sie<\/option><option value=\"Moldavie\" data-country-code=\"MD\" >Moldavie<\/option><option value=\"Monaco\" data-country-code=\"MC\" >Monaco<\/option><option value=\"Mongolie\" data-country-code=\"MN\" >Mongolie<\/option><option value=\"Montserrat\" data-country-code=\"MS\" >Montserrat<\/option><option value=\"Mont\u00e9n\u00e9gro\" data-country-code=\"ME\" >Mont\u00e9n\u00e9gro<\/option><option value=\"Mozambique\" data-country-code=\"MZ\" >Mozambique<\/option><option value=\"Myanmar\" data-country-code=\"MM\" >Myanmar<\/option><option value=\"Namibie\" data-country-code=\"NA\" >Namibie<\/option><option value=\"Nauru\" data-country-code=\"NR\" >Nauru<\/option><option value=\"Nicaragua\" data-country-code=\"NI\" >Nicaragua<\/option><option value=\"Niger\" data-country-code=\"NE\" >Niger<\/option><option value=\"Nigeria\" data-country-code=\"NG\" >Nigeria<\/option><option value=\"Niu\u00e9\" data-country-code=\"NU\" >Niu\u00e9<\/option><option value=\"Norv\u00e8ge\" data-country-code=\"NO\" >Norv\u00e8ge<\/option><option value=\"Nouvelle Zelande\" data-country-code=\"NZ\" >Nouvelle Zelande<\/option><option value=\"Nouvelle-Cal\u00e9donie\" data-country-code=\"NC\" >Nouvelle-Cal\u00e9donie<\/option><option value=\"N\u00e9pal\" data-country-code=\"NP\" >N\u00e9pal<\/option><option value=\"Oman\" data-country-code=\"OM\" >Oman<\/option><option value=\"Ouganda\" data-country-code=\"UG\" >Ouganda<\/option><option value=\"Ouzb\u00e9kistan\" data-country-code=\"UZ\" >Ouzb\u00e9kistan<\/option><option value=\"Pakistan\" data-country-code=\"PK\" >Pakistan<\/option><option value=\"Palau\" data-country-code=\"PW\" >Palau<\/option><option value=\"Palestine, \u00c9tat de\" data-country-code=\"PS\" >Palestine, \u00c9tat de<\/option><option value=\"Panama\" data-country-code=\"PA\" >Panama<\/option><option value=\"Papouasie-Nouvelle-Guin\u00e9e\" data-country-code=\"PG\" >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value=\"Paraguay\" data-country-code=\"PY\" >Paraguay<\/option><option value=\"Pays-Bas\" data-country-code=\"NL\" >Pays-Bas<\/option><option value=\"Philippines\" data-country-code=\"PH\" >Philippines<\/option><option value=\"Pologne\" data-country-code=\"PL\" >Pologne<\/option><option value=\"Polyn\u00e9sie Fran\u00e7aise\" data-country-code=\"PF\" >Polyn\u00e9sie Fran\u00e7aise<\/option><option value=\"Porto Rico\" data-country-code=\"PR\" >Porto Rico<\/option><option value=\"Portugal\" data-country-code=\"PT\" >Portugal<\/option><option value=\"P\u00e9rou\" data-country-code=\"PE\" >P\u00e9rou<\/option><option value=\"Qatar\" data-country-code=\"QA\" >Qatar<\/option><option value=\"Roumanie\" data-country-code=\"RO\" >Roumanie<\/option><option value=\"Royaume-Uni\" data-country-code=\"GB\" >Royaume-Uni<\/option><option value=\"Russie\" data-country-code=\"RU\" >Russie<\/option><option value=\"Rwanda\" data-country-code=\"RW\" >Rwanda<\/option><option value=\"R\u00e9publique Centrafricaine\" data-country-code=\"CF\" >R\u00e9publique Centrafricaine<\/option><option value=\"R\u00e9publique Dominicaine\" data-country-code=\"DO\" >R\u00e9publique Dominicaine<\/option><option value=\"R\u00e9publique Tch\u00e8que\" data-country-code=\"CZ\" >R\u00e9publique Tch\u00e8que<\/option><option value=\"R\u00e9publique du Salvador\" data-country-code=\"SV\" >R\u00e9publique du Salvador<\/option><option value=\"R\u00e9publique d\u00e9mocratique populaire du Laos\" data-country-code=\"LA\" >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value=\"Sahara occidental\" data-country-code=\"EH\" >Sahara occidental<\/option><option value=\"Saint Pierre et Miquelon\" data-country-code=\"PM\" >Saint Pierre et Miquelon<\/option><option value=\"Saint-Kitts-et-Nevis\" data-country-code=\"KN\" >Saint-Kitts-et-Nevis<\/option><option value=\"Saint-Marin\" data-country-code=\"SM\" >Saint-Marin<\/option><option value=\"Saint-Martin (Royaume des Pays-Bas)\" data-country-code=\"MF\" >Saint-Martin (Royaume des Pays-Bas)<\/option><option value=\"Saint-Vincent-et-les-Grenadines\" data-country-code=\"VC\" >Saint-Vincent-et-les-Grenadines<\/option><option value=\"Sainte Lucie\" data-country-code=\"LC\" >Sainte Lucie<\/option><option value=\"Sainte-H\u00e9l\u00e8ne\" data-country-code=\"SH\" >Sainte-H\u00e9l\u00e8ne<\/option><option value=\"Samoa\" data-country-code=\"WS\" >Samoa<\/option><option value=\"Samoa am\u00e9ricaines\" data-country-code=\"AS\" >Samoa am\u00e9ricaines<\/option><option value=\"Sao Tom\u00e9-et-Principe\" data-country-code=\"ST\" >Sao Tom\u00e9-et-Principe<\/option><option value=\"Serbie\" data-country-code=\"RS\" >Serbie<\/option><option value=\"Seychelles\" data-country-code=\"SC\" >Seychelles<\/option><option value=\"Sierra Leone\" data-country-code=\"SL\" >Sierra Leone<\/option><option value=\"Singapour\" data-country-code=\"SG\" >Singapour<\/option><option value=\"Slovaquie\" data-country-code=\"SK\" >Slovaquie<\/option><option value=\"Slov\u00e9nie\" data-country-code=\"SI\" >Slov\u00e9nie<\/option><option value=\"Somalie\" data-country-code=\"SO\" >Somalie<\/option><option value=\"Soudan\" data-country-code=\"SD\" >Soudan<\/option><option value=\"Soudan, Sud\" data-country-code=\"SS\" >Soudan, Sud<\/option><option value=\"Sri Lanka\" data-country-code=\"LK\" >Sri Lanka<\/option><option value=\"Suisse\" data-country-code=\"CH\" >Suisse<\/option><option value=\"Suriname\" data-country-code=\"SR\" >Suriname<\/option><option value=\"Su\u00e8de\" data-country-code=\"SE\" >Su\u00e8de<\/option><option value=\"Svalbard et Jan Mayen\" data-country-code=\"SJ\" >Svalbard et Jan Mayen<\/option><option value=\"Swaziland\" data-country-code=\"SZ\" >Swaziland<\/option><option value=\"Syrie\" data-country-code=\"SY\" >Syrie<\/option><option value=\"S\u00e9n\u00e9gal\" data-country-code=\"SN\" >S\u00e9n\u00e9gal<\/option><option value=\"Tadjikistan\" data-country-code=\"TJ\" >Tadjikistan<\/option><option value=\"Taiwan, R\u00e9publique de Chine\" data-country-code=\"TW\" >Taiwan, R\u00e9publique de Chine<\/option><option value=\"Tanzanie\" data-country-code=\"TZ\" >Tanzanie<\/option><option value=\"Tchad\" data-country-code=\"TD\" >Tchad<\/option><option value=\"Terres australes et antarctiques fran\u00e7aises\" data-country-code=\"TF\" >Terres australes et antarctiques fran\u00e7aises<\/option><option value=\"Territoire britannique de l\u2019oc\u00e9an Indien\" data-country-code=\"IO\" >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value=\"Tha\u00eflande\" data-country-code=\"TH\" >Tha\u00eflande<\/option><option value=\"Timor-Oriental\" data-country-code=\"TL\" >Timor-Oriental<\/option><option value=\"Togo\" data-country-code=\"TG\" >Togo<\/option><option value=\"Tokelau\" data-country-code=\"TK\" >Tokelau<\/option><option value=\"Tonga\" data-country-code=\"TO\" >Tonga<\/option><option value=\"Trinit\u00e9 et Tobago\" data-country-code=\"TT\" >Trinit\u00e9 et Tobago<\/option><option value=\"Tunisie\" data-country-code=\"TN\" >Tunisie<\/option><option value=\"Turkm\u00e9nistan\" data-country-code=\"TM\" >Turkm\u00e9nistan<\/option><option value=\"Turquie\" data-country-code=\"TR\" >Turquie<\/option><option value=\"Tuvalu\" data-country-code=\"TV\" >Tuvalu<\/option><option value=\"Ukraine\" data-country-code=\"UA\" >Ukraine<\/option><option value=\"Uruguay\" data-country-code=\"UY\" >Uruguay<\/option><option value=\"Vanuatu\" data-country-code=\"VU\" >Vanuatu<\/option><option value=\"Vietnam\" data-country-code=\"VN\" >Vietnam<\/option><option value=\"V\u00e9n\u00e9zu\u00e9la\" data-country-code=\"VE\" >V\u00e9n\u00e9zu\u00e9la<\/option><option value=\"Yemen\" data-country-code=\"YE\" >Yemen<\/option><option value=\"Zambie\" data-country-code=\"ZM\" >Zambie<\/option><option value=\"Zimbabwe\" data-country-code=\"ZW\" >Zimbabwe<\/option><option value=\"\u00c9gypte\" data-country-code=\"EG\" >\u00c9gypte<\/option><option value=\"\u00c9mirats Arabes Unis\" data-country-code=\"AE\" >\u00c9mirats Arabes Unis<\/option><option value=\"\u00c9quateur\" data-country-code=\"EC\" >\u00c9quateur<\/option><option value=\"\u00c9rythr\u00e9e\" data-country-code=\"ER\" >\u00c9rythr\u00e9e<\/option><option value=\"\u00c9tats-Unis d\u2019Am\u00e9rique (USA)\" data-country-code=\"US\" >\u00c9tats-Unis d\u2019Am\u00e9rique (USA)<\/option><option value=\"\u00c9thiopie\" data-country-code=\"ET\" >\u00c9thiopie<\/option><option value=\"\u00cele Bouvet\" data-country-code=\"BV\" >\u00cele Bouvet<\/option><option value=\"\u00cele Christmas\" data-country-code=\"CX\" >\u00cele Christmas<\/option><option value=\"\u00cele Heard et \u00eele Mcdonald\" data-country-code=\"HM\" >\u00cele Heard et \u00eele Mcdonald<\/option><option value=\"\u00cele Johnston\" data-country-code=\"JT\" >\u00cele Johnston<\/option><option value=\"\u00cele Maurice\" data-country-code=\"MU\" >\u00cele Maurice<\/option><option value=\"\u00cele Norfolk\" data-country-code=\"NF\" >\u00cele Norfolk<\/option><option value=\"\u00cele de la R\u00e9union\" data-country-code=\"RE\" >\u00cele de la R\u00e9union<\/option><option value=\"\u00celes Ca\u00efmans\" data-country-code=\"KY\" >\u00celes Ca\u00efmans<\/option><option value=\"\u00celes Cocos\" data-country-code=\"CC\" >\u00celes Cocos<\/option><option value=\"\u00celes Cook\" data-country-code=\"CK\" >\u00celes Cook<\/option><option value=\"\u00celes Falkland\" data-country-code=\"FK\" >\u00celes Falkland<\/option><option value=\"\u00celes F\u00e9ro\u00e9\" data-country-code=\"FO\" >\u00celes F\u00e9ro\u00e9<\/option><option value=\"\u00celes Mariannes du Nord\" data-country-code=\"MP\" >\u00celes Mariannes du Nord<\/option><option value=\"\u00celes Marshall\" data-country-code=\"MH\" >\u00celes Marshall<\/option><option value=\"\u00celes Pitcairn\" data-country-code=\"PN\" >\u00celes Pitcairn<\/option><option value=\"\u00celes Salomon\" data-country-code=\"SB\" >\u00celes Salomon<\/option><option value=\"\u00celes Turques-et-Ca\u00efques\" data-country-code=\"TC\" >\u00celes Turques-et-Ca\u00efques<\/option><option value=\"\u00celes Vierges am\u00e9ricaines\" data-country-code=\"VI\" >\u00celes Vierges am\u00e9ricaines<\/option><option value=\"\u00celes Vierges britanniques\" data-country-code=\"VG\" >\u00celes Vierges britanniques<\/option><option value=\"\u00celes Wallis et Futuna\" data-country-code=\"WF\" >\u00celes Wallis et Futuna<\/option><option value=\"\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis\" data-country-code=\"UM\" >\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-254--page-1\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-254--page-1-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"1\"\r\n\t\t\t\tdata-label=\"Personal Information\"\r\n\t\t\t\tdata-actual-label=\"Diving Information\"\r\n\t\t\t\tdata-name=\"page-break-4\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_69eb8d7746dee\" id=\"forminator-field-date-1-picker_69eb8d7746dee-label\" class=\"forminator-label\">Date of Last Dive<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-1-picker_69eb8d7746dee\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" aria-describedby=\"forminator-field-date-1-picker_69eb8d7746dee-description\" \/><\/div><span id=\"forminator-field-date-1-picker_69eb8d7746dee-description\" class=\"forminator-description\">Remember to bring your logbook!<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-1\" class=\"forminator-field-number forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_69eb8d7746dee\" id=\"forminator-field-number-1_69eb8d7746dee-label\" class=\"forminator-label\">Total Number of Dives <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-1\" value=\"0\" placeholder=\"E.g. 10\" id=\"forminator-field-number-1_69eb8d7746dee\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69eb8d7746dee\" id=\"forminator-field-text-1_69eb8d7746dee-label\" class=\"forminator-label\">Qualification Level <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"None\" placeholder=\"E.g. PADI Open Water\" id=\"forminator-field-text-1_69eb8d7746dee\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"100\" \/><span id=\"forminator-field-text-1_69eb8d7746dee-description\" class=\"forminator-description\"><span data-limit=\"100\" data-type=\"characters\">0 \/ 100<\/span><\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-2\" class=\"forminator-field-number forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_69eb8d7746dee\" id=\"forminator-field-number-2_69eb8d7746dee-label\" class=\"forminator-label\">Qualification Maximum Depth (metres) <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-2\" value=\"0\" placeholder=\"E.g. 10\" id=\"forminator-field-number-2_69eb8d7746dee\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"0\" max=\"150\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_69eb8d7746dee\" id=\"forminator-field-upload-1_69eb8d7746dee-label\" class=\"forminator-label\">Qualification Card<\/label><div class=\"forminator-file-upload\" data-element=\"upload-1_69eb8d7746dee\" aria-describedby=\"forminator-field-upload-1_69eb8d7746dee-description\"><input type=\"file\" name=\"upload-1\" id=\"forminator-field-upload-1_69eb8d7746dee\" class=\"forminator-input-file\" accept=\".jpg,.jpeg,.jpe,.png,.gif,.webp,.mov,.qt,.avif,.avi,.mpeg,.mpg,.mpe,.3gp,.3gpp,.3g2,.3gp2,.mid,.midi,.pdf,.doc,.docx,.docm,.pot,.pps,.ppt,.pptx,.pptm,.odt,.ppsx,.ppsm,.xla,.xls,.xlt,.xlw,.xlsx,.xlsm,.xlsb,.key,.mp3,.m4a,.m4b,.ogg,.oga,.flac,.wav,.mp4,.m4v,.webm,.ogv,.flv\" tabindex=\"-1\"><button id=\"forminator-field-upload-1_69eb8d7746dee_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-1_69eb8d7746dee\">Choisissez un fichier<\/button><span data-empty-text=\"Aucun fichier s\u00e9lectionn\u00e9\">Aucun fichier s\u00e9lectionn\u00e9<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Supprimer le fichier t\u00e9l\u00e9vers\u00e9<\/span><\/button><\/div><span id=\"forminator-field-upload-1_69eb8d7746dee-description\" class=\"forminator-description\">Picture of your Qualification Card, up to 15MB total size. Remember to bring it!<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_69eb8d7746dee\" id=\"forminator-field-name-2_69eb8d7746dee-label\" class=\"forminator-label\">Emergency Contact Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-2_69eb8d7746dee\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_69eb8d7746dee\" id=\"forminator-field-phone-2_69eb8d7746dee-label\" class=\"forminator-label\">Emergency Contact Phone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"E.g. +1 300 400 5000\" id=\"forminator-field-phone-2_69eb8d7746dee\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-28\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-28-69eb8d7746dee-label\" aria-describedby=\"forminator-radiogroup-radio-28-69eb8d7746dee-description\"><span id=\"forminator-radiogroup-radio-28-69eb8d7746dee-label\" class=\"forminator-label\">No-fly within 24 hours Confirmation <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-28-label-1\" for=\"forminator-field-radio-28-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Confirm\"><input type=\"radio\" name=\"radio-28\" value=\"one\" id=\"forminator-field-radio-28-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-28-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-28-69eb8d7746dee-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Confirm<\/span><\/label><span id=\"forminator-radiogroup-radio-28-69eb8d7746dee-description\" class=\"forminator-description\">You must not fly until at least 24 hours after any Scuba Diving activity.<\/span><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-254--page-2\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-254--page-2-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"2\"\r\n\t\t\t\tdata-label=\"Diving Information\"\r\n\t\t\t\tdata-actual-label=\"MUST Consult\"\r\n\t\t\t\tdata-name=\"page-break-3\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">You MUST consult a Qualified Physician if you have any of the following:<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-1-69eb8d7746dee-label\" class=\"forminator-label\">You are pregnant or you suspect you may be pregnant <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-27\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-27-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-27-69eb8d7746dee-label\" class=\"forminator-label\">You regularly take medication (with the exception of birth control) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-27-label-1\" for=\"forminator-field-radio-27-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-27\" value=\"one\" id=\"forminator-field-radio-27-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-27-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-27-label-2\" for=\"forminator-field-radio-27-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-27\" value=\"two\" id=\"forminator-field-radio-27-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-27-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-2-69eb8d7746dee-label\" class=\"forminator-label\">You are over 45 years of age and smoke <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-3-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-3-69eb8d7746dee-label\" class=\"forminator-label\">You are over 45 years of age and have a high cholesterol level <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-3\" value=\"one\" id=\"forminator-field-radio-3-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-3\" value=\"two\" id=\"forminator-field-radio-3-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-254--page-3\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-254--page-3-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"3\"\r\n\t\t\t\tdata-label=\"MUST Consult\"\r\n\t\t\t\tdata-actual-label=\"SHOULD Consult\"\r\n\t\t\t\tdata-name=\"page-break-2\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">You SHOULD consult a Qualified Physician if you have ever had:<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-4\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-4-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-4-69eb8d7746dee-label\" class=\"forminator-label\">Asthma, or wheezing with breathing, or wheezing with exercise <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-4-label-1\" for=\"forminator-field-radio-4-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-4\" value=\"one\" id=\"forminator-field-radio-4-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-4-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-4-label-2\" for=\"forminator-field-radio-4-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-4\" value=\"two\" id=\"forminator-field-radio-4-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-4-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-5\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-5-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-5-69eb8d7746dee-label\" class=\"forminator-label\">Any form of lung disease <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-5-label-1\" for=\"forminator-field-radio-5-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-5\" value=\"one\" id=\"forminator-field-radio-5-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-5-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-5-label-2\" for=\"forminator-field-radio-5-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-5\" value=\"two\" id=\"forminator-field-radio-5-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-5-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-6\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-6-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-6-69eb8d7746dee-label\" class=\"forminator-label\">Pneumothorax (collapsed lung) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-6-label-1\" for=\"forminator-field-radio-6-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-6\" value=\"one\" id=\"forminator-field-radio-6-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-6-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-6-label-2\" for=\"forminator-field-radio-6-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-6\" value=\"two\" id=\"forminator-field-radio-6-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-6-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-7\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-7-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-7-69eb8d7746dee-label\" class=\"forminator-label\">History of chest surgery <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-7-label-1\" for=\"forminator-field-radio-7-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-7\" value=\"one\" id=\"forminator-field-radio-7-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-7-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-7-label-2\" for=\"forminator-field-radio-7-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-7\" value=\"two\" id=\"forminator-field-radio-7-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-7-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-8\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-8-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-8-69eb8d7746dee-label\" class=\"forminator-label\">Claustrophobia or agoraphobia (fear of closed or open spaces) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-8-label-1\" for=\"forminator-field-radio-8-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-8\" value=\"one\" id=\"forminator-field-radio-8-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-8-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-8-label-2\" for=\"forminator-field-radio-8-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-8\" value=\"two\" id=\"forminator-field-radio-8-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-8-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-9\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-9-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-9-69eb8d7746dee-label\" class=\"forminator-label\">Epilepsy, seizures, convulsions or take medications to prevent them <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-9-label-1\" for=\"forminator-field-radio-9-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-9\" value=\"one\" id=\"forminator-field-radio-9-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-9-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-9-label-2\" for=\"forminator-field-radio-9-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-9\" value=\"two\" id=\"forminator-field-radio-9-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-9-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-10\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-10-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-10-69eb8d7746dee-label\" class=\"forminator-label\">History of blackouts or fainting (full\/partial loss of consciousness) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-10-label-1\" for=\"forminator-field-radio-10-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-10\" value=\"one\" id=\"forminator-field-radio-10-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-10-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-10-label-2\" for=\"forminator-field-radio-10-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-10\" value=\"two\" id=\"forminator-field-radio-10-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-10-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-11\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-11-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-11-69eb8d7746dee-label\" class=\"forminator-label\">History of diving accidents or decompression sickness <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-11-label-1\" for=\"forminator-field-radio-11-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-11\" value=\"one\" id=\"forminator-field-radio-11-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-11-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-11-label-2\" for=\"forminator-field-radio-11-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-11\" value=\"two\" id=\"forminator-field-radio-11-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-11-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-12\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-12-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-12-69eb8d7746dee-label\" class=\"forminator-label\">History of diabetes <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-12-label-1\" for=\"forminator-field-radio-12-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-12\" value=\"one\" id=\"forminator-field-radio-12-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-12-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-12-label-2\" for=\"forminator-field-radio-12-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-12\" value=\"two\" id=\"forminator-field-radio-12-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-12-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-13\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-13-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-13-69eb8d7746dee-label\" class=\"forminator-label\">History of high blood pressure or take medications to control blood pressure <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-13-label-1\" for=\"forminator-field-radio-13-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-13\" value=\"one\" id=\"forminator-field-radio-13-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-13-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-13-label-2\" for=\"forminator-field-radio-13-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-13\" value=\"two\" id=\"forminator-field-radio-13-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-13-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-14\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-14-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-14-69eb8d7746dee-label\" class=\"forminator-label\">History of any heart disease <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-14-label-1\" for=\"forminator-field-radio-14-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-14\" value=\"one\" id=\"forminator-field-radio-14-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-14-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-14-label-2\" for=\"forminator-field-radio-14-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-14\" value=\"two\" id=\"forminator-field-radio-14-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-14-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-15\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-15-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-15-69eb8d7746dee-label\" class=\"forminator-label\">History of ear disease, hearing loss or problems with balance <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-15-label-1\" for=\"forminator-field-radio-15-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-15\" value=\"one\" id=\"forminator-field-radio-15-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-15-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-15-label-2\" for=\"forminator-field-radio-15-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-15\" value=\"two\" id=\"forminator-field-radio-15-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-15-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-16\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-16-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-16-69eb8d7746dee-label\" class=\"forminator-label\">History of thrombosis or blood clotting <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-16-label-1\" for=\"forminator-field-radio-16-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-16\" value=\"one\" id=\"forminator-field-radio-16-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-16-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-16-label-2\" for=\"forminator-field-radio-16-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-16\" value=\"two\" id=\"forminator-field-radio-16-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-16-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-17\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-17-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-17-69eb8d7746dee-label\" class=\"forminator-label\">Psychiatric diseases <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-17-label-1\" for=\"forminator-field-radio-17-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-17\" value=\"one\" id=\"forminator-field-radio-17-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-17-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-17-label-2\" for=\"forminator-field-radio-17-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-17\" value=\"two\" id=\"forminator-field-radio-17-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-17-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-254--page-4\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-254--page-4-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"4\"\r\n\t\t\t\tdata-label=\"SHOULD Consult\"\r\n\t\t\t\tdata-actual-label=\"AWARE Of\"\r\n\t\t\t\tdata-name=\"page-break-5\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-3\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">You are AWARE that you could be unfit to dive if you have or develop during the course, any of the following conditions:<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-18\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-18-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-18-69eb8d7746dee-label\" class=\"forminator-label\">Cold, sinusitis, or any breathing problems (e.g. bronchitis, hay fever) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-18-label-1\" for=\"forminator-field-radio-18-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Confirm\"><input type=\"radio\" name=\"radio-18\" value=\"one\" id=\"forminator-field-radio-18-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-18-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Confirm<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-19\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-19-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-19-69eb8d7746dee-label\" class=\"forminator-label\">Acute migraine or headache <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-19-label-1\" for=\"forminator-field-radio-19-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Confirm\"><input type=\"radio\" name=\"radio-19\" value=\"one\" id=\"forminator-field-radio-19-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-19-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Confirm<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-20\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-20-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-20-69eb8d7746dee-label\" class=\"forminator-label\">Any kind of surgery within the last 6 weeks <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-20-label-1\" for=\"forminator-field-radio-20-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Confirm\"><input type=\"radio\" name=\"radio-20\" value=\"one\" id=\"forminator-field-radio-20-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-20-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Confirm<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-21\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-21-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-21-69eb8d7746dee-label\" class=\"forminator-label\">Under influence of alcohol, drugs or medications affecting the ability to react <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-21-label-1\" for=\"forminator-field-radio-21-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Confirm\"><input type=\"radio\" name=\"radio-21\" value=\"one\" id=\"forminator-field-radio-21-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-21-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Confirm<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-22\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-22-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-22-69eb8d7746dee-label\" class=\"forminator-label\">Fever, dizziness, nausea, vomiting and diarrhoea <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-22-label-1\" for=\"forminator-field-radio-22-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Confirm\"><input type=\"radio\" name=\"radio-22\" value=\"one\" id=\"forminator-field-radio-22-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-22-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Confirm<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-23\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-23-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-23-69eb8d7746dee-label\" class=\"forminator-label\">Problems equalizing (popping ears) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-23-label-1\" for=\"forminator-field-radio-23-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Confirm\"><input type=\"radio\" name=\"radio-23\" value=\"one\" id=\"forminator-field-radio-23-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-23-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Confirm<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-24\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-24-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-24-69eb8d7746dee-label\" class=\"forminator-label\">Acute gastric ulcers <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-24-label-1\" for=\"forminator-field-radio-24-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Confirm\"><input type=\"radio\" name=\"radio-24\" value=\"one\" id=\"forminator-field-radio-24-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-24-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Confirm<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-25\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-25-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-25-69eb8d7746dee-label\" class=\"forminator-label\">Pregnancy <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-25-label-1\" for=\"forminator-field-radio-25-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Confirm\"><input type=\"radio\" name=\"radio-25\" value=\"one\" id=\"forminator-field-radio-25-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-25-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Confirm<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-254--page-5\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-254--page-5-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"5\"\r\n\t\t\t\tdata-label=\"AWARE Of\"\r\n\t\t\t\tdata-actual-label=\"Medical Information\"\r\n\t\t\t\tdata-name=\"page-break-7\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-5\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Medical Certificate<\/h2><h3 class=\"forminator-subtitle\">Please upload your medical certificate if required.<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-2\" class=\"forminator-field-upload forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-2_69eb8d7746dee\" id=\"forminator-field-upload-2_69eb8d7746dee-label\" class=\"forminator-label\">Medical Certificate<\/label><div class=\"forminator-file-upload\" data-element=\"upload-2_69eb8d7746dee\" aria-describedby=\"forminator-field-upload-2_69eb8d7746dee-description\"><input type=\"file\" name=\"upload-2\" id=\"forminator-field-upload-2_69eb8d7746dee\" class=\"forminator-input-file\" accept=\".jpg,.jpeg,.jpe,.png,.gif,.webp,.mov,.qt,.avif,.avi,.mpeg,.mpg,.mpe,.3gp,.3gpp,.3g2,.3gp2,.mid,.midi,.pdf,.doc,.docx,.docm,.pot,.pps,.ppt,.pptx,.pptm,.odt,.ppsx,.ppsm,.xla,.xls,.xlt,.xlw,.xlsx,.xlsm,.xlsb,.key,.mp3,.m4a,.m4b,.ogg,.oga,.flac,.wav,.mp4,.m4v,.webm,.ogv,.flv,.txt,.7z,.bz2,.gz,.tgz,.txz,.xz,.zip\" tabindex=\"-1\"><button id=\"forminator-field-upload-2_69eb8d7746dee_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-2_69eb8d7746dee\">Choisissez un fichier<\/button><span data-empty-text=\"Aucun fichier s\u00e9lectionn\u00e9\">Aucun fichier s\u00e9lectionn\u00e9<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Supprimer le fichier t\u00e9l\u00e9vers\u00e9<\/span><\/button><\/div><span id=\"forminator-field-upload-2_69eb8d7746dee-description\" class=\"forminator-description\">Medical Certificate, if required. Up to 15MB in size<\/span><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-254--page-6\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-254--page-6-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"6\"\r\n\t\t\t\tdata-label=\"Medical Information\"\r\n\t\t\t\tdata-actual-label=\"Parent \/ Guardian Consent\"\r\n\t\t\t\tdata-name=\"page-break-6\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-4\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Parent \/ Guardian<\/h2><h3 class=\"forminator-subtitle\">I, the undersigned parent\/guardian, hereby give permission for my child to participate in scuba diving activities organized by Captain Mimi&#039;s Diving Center. I understand that scuba diving involves inherent risks, including but not limited to physical injury, drowning, and other potential hazards. I agree to release, waive, and hold harmless Captain Mimi&#039;s Diving Center, its instructors, employees, and volunteers from any liability, claims, demands, or causes of action that may arise from my child&#039;s participation in this activity. Medical Information: I confirm that my child is in good health and does not have any medical conditions that would prevent them from participating in scuba diving activities. If my child requires any special accommodations, I have listed them below.<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-name-3_69eb8d7746dee\" id=\"forminator-field-name-3_69eb8d7746dee-label\" class=\"forminator-label\">Name of Parent \/ Guardian<\/label><input type=\"text\" name=\"name-3\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-3_69eb8d7746dee\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-3\" class=\"forminator-field-phone forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-3_69eb8d7746dee\" id=\"forminator-field-phone-3_69eb8d7746dee-label\" class=\"forminator-label\">Phone<\/label><input type=\"text\" name=\"phone-3\" value=\"\" placeholder=\"E.g. +1 300 400 5000\" id=\"forminator-field-phone-3_69eb8d7746dee\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_69eb8d7746dee\" id=\"forminator-field-textarea-1_69eb8d7746dee-label\" class=\"forminator-label\">Any Special Accommodations:<\/label><textarea name=\"textarea-1\" placeholder=\"Special Accommodations\" id=\"forminator-field-textarea-1_69eb8d7746dee\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-254--page-7\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-254--page-7-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"7\"\r\n\t\t\t\tdata-label=\"Parent \/ Guardian Consent\"\r\n\t\t\t\tdata-actual-label=\"Liability &amp; Contact\"\r\n\t\t\t\tdata-name=\"\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-6\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Liability &amp; Contact<\/h2><h3 class=\"forminator-subtitle\">I, the undersigned participant, hereby acknowledge and agree that scuba diving is an inherently risky activity that may result in physical injury, drowning, or other hazards. By signing this waiver, I agree to release, waive, discharge, and hold harmless Captain Mimi&#039;s Diving Center, its instructors, employees, and volunteers from any liability, claims, demands, or causes of action that may arise from my participation in this scuba diving activity. I understand and agree that this waiver and release of liability extends to any and all claims of every nature and kind, including, but not limited to, any claims for bodily injury, property damage, or wrongful death arising out of my participation in this scuba diving activity. Assumption of Risk: I confirm that I am in good health and do not have any medical conditions that would prevent me from participating in scuba diving activities. I acknowledge that I am voluntarily participating in this activity and assume all risks associated with it. Medical Information: I agree to disclose any medical conditions or required accommodations to the scuba diving instructors prior to participation. If I require emergency medical treatment during the activity, I give my consent for Captain Mimi&#039;s Diving Center to seek such treatment on my behalf. Insurance: I acknowledge that I have an adequate insurance policy that covers the activities that I will be participating in. Acknowledgement and Agreement: I have read and understood the risks associated with scuba diving. By signing below, I voluntarily agree to the terms and conditions outlined in this liability release waiver.<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"signature-1\" class=\"forminator-field-signature forminator-col forminator-col-12\"><div class=\"forminator-field forminator-field-signature\"><label for=\"forminator-field-ctlSignature69eb8d77488aa\" id=\"forminator-field-ctlSignature69eb8d77488aa-label\" class=\"forminator-label\">Signature of Participant <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-signature\" data-elementheight=\"180\"><span id=\"ctlSignature69eb8d77488aa_placeholder\" class=\"forminator-signature--placeholder\" aria-hidden=\"true\">Start signing your signature here<\/span><div id=\"ctlSignature69eb8d77488aa_Container\" class=\"forminator-signature--container\"><canvas id=\"ctlSignature69eb8d77488aa\" class=\"forminator-signature-canvas\" height=\"180\" tabindex=\"-1\"><p>Your browser does not support e-Signature field.<\/p><\/canvas><\/div><\/div><input type=\"hidden\" name=\"field-signature-1\" value=\"69eb8d77488aa\" class=\"signature-prefix\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-26\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-26-69eb8d7746dee-label\"><span id=\"forminator-radiogroup-radio-26-69eb8d7746dee-label\" class=\"forminator-label\">May we contact you for marketing purposes using the provided contact details? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-26-label-1\" for=\"forminator-field-radio-26-1-69eb8d7746dee\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-26\" value=\"one\" id=\"forminator-field-radio-26-1-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-26-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-26-label-2\" for=\"forminator-field-radio-26-2-69eb8d7746dee\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-26\" value=\"two\" id=\"forminator-field-radio-26-2-69eb8d7746dee\" aria-labelledby=\"forminator-field-radio-26-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_69eb8d7746dee\" id=\"forminator-field-consent-1_69eb8d7746dee-label\" class=\"forminator-label\">Consent <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_69eb8d7746dee__label\" class=\"forminator-checkbox forminator-consent\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_69eb8d7746dee\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_69eb8d7746dee-label\" aria-describedby=\"forminator-field-consent-1_69eb8d7746dee__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_69eb8d7746dee__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>Yes, I agree with the <a rel=\"noopener\" target=\"_blank\" href=\"https:\/\/captain-mimis-diving-center.com\/fr\/privacy-policy\/\">privacy policy<\/a> and <a rel=\"noopener\" target=\"_blank\" href=\"https:\/\/captain-mimis-diving-center.com\/fr\/terms-and-conditions\/\">terms and conditions<\/a>.<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"captcha-1\" class=\"forminator-field-captcha forminator-col forminator-col-12\"><div class=\"forminator-captcha-left forminator-turnstile\" data-theme=\"auto\" data-language=\"fr-fr\" data-sitekey=\"0x4AAAAAABCTqf3hCioQW-Fb\" data-size=\"normal\"><\/div> <\/div><\/div><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>Submit<\/button><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"2232c255e5\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/fr\/wp-json\/wp\/v2\/pages\/256\" \/><input type=\"hidden\" name=\"form_id\" value=\"254\"><input type=\"hidden\" name=\"page_id\" value=\"256\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/captain-mimis-diving-center.com\/fr\/information-and-medical\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><input type=\"hidden\" name=\"trp-form-language\" value=\"fr\"\/><\/form><\/p>","protected":false},"excerpt":{"rendered":"<p>This is a statement in which you are informed of some potential risks involved in recreational scuba diving and of the conduct required of you during the recreational scuba training. Please ensure you read all sections carefully. You must complete this Medical Statement, which includes the medical-history information section, to enrol in the recreational scuba-training [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_mbp_gutenberg_autopost":false,"slim_seo":{"title":"Personal Information and Medical - Captain Mimi&#039;s Diving Center","description":"This is a statement in which you are informed of some potential risks involved in recreational scuba diving and of the conduct required of you during the recrea"},"footnotes":""},"class_list":["post-256","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/captain-mimis-diving-center.com\/fr\/wp-json\/wp\/v2\/pages\/256","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/captain-mimis-diving-center.com\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/captain-mimis-diving-center.com\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/captain-mimis-diving-center.com\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/captain-mimis-diving-center.com\/fr\/wp-json\/wp\/v2\/comments?post=256"}],"version-history":[{"count":0,"href":"https:\/\/captain-mimis-diving-center.com\/fr\/wp-json\/wp\/v2\/pages\/256\/revisions"}],"wp:attachment":[{"href":"https:\/\/captain-mimis-diving-center.com\/fr\/wp-json\/wp\/v2\/media?parent=256"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}