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CWS - Medical Disclosure

1. Booking details
This question requires a valid date format of DD/MM/YYYY.
The following medical information may be necessary in the event of a serious illness or accident.

The facts you disclose will be kept confidential however will be given to medical personnel or staff only in an emergency situation. This form is to be completed at time of booking and returned to Cruise Whitsundays prior to departure.
2. Your details
This question requires a valid date format of MM/DD/YYYY.
3. Do you have any conditions that may impact your stay while at Reefworld? (E.g. medical, sleep walking, sleep apnea, severe food allergies, etc.) *This question is required.
4. Are you taking any medications that may impact your stay? *This question is required.
5. Are there any specific arrangements required to assist you in a medical emergency  *This question is required.
6. Do you intend to scuba dive during your stay at Reefworld? *This question is required.
7. Please confirm you have read and understood the information provided on our website at Discover Scuba, including the required medical questionnaire. *This question is required.
7. Please provide your emergency contact details
9. Signed by *This question is required.
Signature of
We appreciate your disclosure to on this voluntary form, this will help us ensure your safety whilst at our pontoon.