RSTC Medical Statement

An RSTC medical statement is a document which attests to a participant’s health condition before he or she is allowed to participate in recreational scuba diving. It is mandatory procedure and is followed by all institutions which train individuals to scuba dive. The statement of intent explains why such a procedure has to be followed and it is usually succeeded by a medical questionnaire of the candidate.

Sample RSTC Medical Statement

RECREATIONAL SCUBA TRAINING COUNCIL MEDICAL RECORD AND STATEMENT

PARTICPANT’S RECORD [CONFIDENTIAL INFORMATION

This is a medical statement which apprises you of the risks involved in RECREATIONAL SCUBA TRAINING, offered by WATER SPORTS PVT. LTD. from the 23rd of March 2012 to the 23rd of June 2012. WATER SPORTS PVT. LTD. is located at 12 REDWOOD ROAD, NEAR PENN STATE UNIVERSITY, PENNSYLVANIA.

You are requested to read the statement provided below and fill up the medical questionnaire attached with this document. In case you are a minor, the signature of your legal appointed guardian must also be provided. Your consent, which is indicated by your signature on this document, is necessary for enrolment in the training program.

MEDICAL STATEMENT

Scuba diving is an exciting adventure sport. However, only completely healthy and active individuals are recommended to participate in it. All the air spaces in your body should be uncongested and if you suffer from any of the diseases mentioned in the annex document, like coronary problems, diabetes, asthma, and chronic back ache and so on, you must consult with your physician before attempting scuba diving.

DECLARATION:

“I have read and understood all the terms and conditions contained in this document. I promise to enter correct and accurate information in the medical questionnaire provided. I will also cooperate with the on-site physician in charge of my medical examination. In case of any concealment of information and damage to my health, I shall bear full and complete responsibility.”

Signature of participant: ___________________________________

Signature of physician: _____________________________________

Date: __________________