Diving Ops Participant General

Participant Form

General Trainee (Not Disabled)

Enrollment form for General Trainee for participation in Operation Blue Freedom – Water World Record (March 2021)

*Only Indian Citizens with no disabilities to Apply

Personal Details

Name

Phone

Date of birth

Gender

Pincode

Country

Prior Diving Experience

Languages I can speak

Languages I can read

Do you hold an Indian Passport?

YES NO

If you hold an Indian Passport, enter the expiry date

Can you satisfy performance requirement of non-stop 200m swimming (any style) and 10 meter flotation without diving gear/flotation device?

Preferred Batch
Please choose your preferred Batch based on the information provided in the Diving Ops page

Pick Your preferred Batch

Date of Filling The Form

Time of Filling The Form

Medical & Health Related Status
A brief information about your medical history

Blood Group

Caregiver Required

Dietary Constraints & Allergies (if any)

Brief of medical status (including ailments)

Health Status - Self Declaration

Do you take prescription medication?

YES NO

Are you currently receiving medical care?

YES NO

Are you, or could you be, Pregnant?

YES NO

Do you currently smoke tobacco?

YES NO

Do you have high cholesterol?

YES NO

Asthma or Wheezing with exercise?

YES NO

Seizure disorder, epilepsy or convulsions?

YES NO

Frequent colds, sinusitis or bronchitis?

YES NO

Severe hay fever or allergy?

YES NO

Pneumothorax, collapsed lung?

YES NO

Lung disease?

YES NO

Chest disease or chest surgery?

YES NO

Blackouts or fainting (loss of consciousness)?

YES NO

Diabetes mellitus, even if controlled by diet?

YES NO

Recurring Ear or Sinus problems?

YES NO

Sinus surgery?

YES NO

Ear surgery, loss of hearing or balance?

YES NO

Recurring Headaches or Migraines?

YES NO

Decompression sickness or diving accident?

YES NO

Hernia?

YES NO

Behavioral health, mental or psychological? (Anxiety attacks, fear of open/ closed spaces)

YES NO

Heart disease?

YES NO

Angina, Heart or Blood Vessel surgery?

YES NO

Family history of heart attack or stroke?

YES NO

High blood pressure?

YES NO

High blood pressure medication?

YES NO

Bleeding or other blood disorders?

YES NO

Ulcers or ulcer surgery?

YES NO

Recurring Back problems?

YES NO

Back or spinal surgery?

YES NO

Frequent Motion sickness?

YES NO

Head injury with loss of consciousness?

YES NO

Drug or alcohol treatment in past 5 years?

YES NO

Tracheotomy?

YES NO

Colostomy or ileostomy?

YES NO

Medically treated for dysentery or dehydration?

YES NO

I agree to accept responsibility for omissions regarding my failure to disclose any existing or past health conditions.

Financial Declaration

I confirm that I have the financial resources to meet the training & other costs for participation in the C.L.A.W GLOBAL DIVING OPS.

Self Declaration

I hereby declare that the information given in this application is true and complete. I understand and agree that in the event of my information being found false or incorrect or misleading at any stage, my application and/or participation at any stage shall be liable to cancellation without notice or any compensation or refund whatsoever.

Note:

Applying does not automatically guarantee that the applicant will be selected for participation in the C.L.A.W GLOBAL DIVING OPS. C.L.A.W Global has sole discretion to select the final participants for C.L.A.W GLOBAL DIVING OPS.
The applicant is not eligible for Water World Record as the participants for Water World Record are persons with disabilities.
You shall be required to comply with additional requirements (including acceptance of detailed terms and conditions, mandatory forms & undertakings etc.) in case your application is shortlisted.

By clicking submit, you agree to provide consent to the items mentioned in the consent form.

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