Medical Certification

APNEA.cz - Medical Certificate
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AIDA - Association Internationale pour le Développement de l’Apnée
CMAS - Confédération Mondiale des Activités Subaquatiques
PADI - Professional Association of Diving Instructors


I, the signed certified medical doctor:    
☐ general medical doctor
☐ medical doctor specialized in:   
☐ sport medical doctor
Declare that I examined:
Date 
Family Name Name 
Birthdate 
Address 
And find no medical conditions that I consider incompatible with the following diving disciplines
  • ☐ scuba diving
  • ☑ freediving / breath-hold diving
  • ☐ training or teaching of scuba or breath-hold diving
  • ☐ preparation of the following qualification:
  •  
     
  • ☐ participation in scuba-diving competitions
  • ☑ participation in freediving competitions
  • ☐ the following underwater sport or activity
  •  
     
Notes or restrictions:
Date
place
Sign and stamp with address and phone#

Number of checked boxes:  ☐ (mandatory)
This medical certificate is valid for one year, with the exception of a disease, injury, or a diving accident, in which case it needs to be renewed. The examined person was informed about health risks, especially in case of a wrongful declaration.