MEDICAL STATEMENT

To be read and signed by each participant

• Participants wear a tight and constricting full body heavy drysuit that may make walking dif ficult.
• Because of the geographical layout of Silfra, participants must walk in full gear about
  200 meters to the entry point and later 500 meters from the exit stairs back to where we started.
• The drysuit has tight seals on the neck and wrists that stop water from getting in.
  An additional rubber strap worn around the neck may be needed to make it watertight.
• In-water duration is 30-45 minutes and the water temperature is 3° Celsius (37°F) . For this reason,participants should have eaten breakfast or lunch before the activity starts.
• Participants wear a wet neoprene hood and gloves. This means that the head and hands are partially exposed to the water. Part of the face will not be covered by the hood and therefore be in direct contact with the water.
• There is a slight current in Silfra and participants must be comfortable swimming against it during the last part of the tour.
• There is a small chance of the drysuit leaking. Please bring a second set of the clothes you plan to wear under the drysuit (underwear/leggings/long sleeve/thermals).
• Participants use a snorkel to breathe throughout the activity.
• Silfra is situated in the Thingvellir national park. This is a UNESCO World Heritage Park and
  constructions are not allowed. This means that participants must change in potentially wet, windy,and cold weather conditions. In winter, outside temperatures in Iceland may be far below the freezing point.
• Participants should bring adequate thermal protection for the time before and after the tour and keep in mind that the weather in Iceland may change within minutes. Make sure to have a hat and gloves along during winter!

Please answer the following questions about your past and current medical history:

A YES or NO must be written for each question
Section 1: A YES in this section means that unfortunately we cannot take you on our

snorkeling tour for your own safety!

______ Extreme difficulty to perform moderate physical exercise and walk 1 km?

______ Are you pregnant?

______ Any form of lung disease? Pneumothorax (collapsed lung)?

______ Any kind of heart disease?
______ Heart surgery or heart attack in the past 5 years ?
______ Head injury with loss of consciousness in the past 6 months?

______ Colostomy, urostomy or ileostomy?

______ Epilepsy or condition resulting in sudden lost of consciousness?

Section 2: A YES in this section means that you need to get a medical clearance from

a doctor before your tour*. You can find the required medical form of this pdf.

* Medication can not be taken into the water.

______ Under medical care/medication that might affect your ability to perform the tour?

______ High cholesterol, or taking medicine to control it?

______ High or low blood pressure, or taking medicine to control it?
______ Diabetes Mellitus, even controlled by diet alone? Taking medication for diabetes?

______ Asthma in the past 5 years? Using an inhaler for asthma or respiratory problem?

______ Wheezing when breathing or wheezing with moderate exercise?
______ Behavioral or mental health problems (panic, fear of closed/open spaces)?
______ Back, arm or leg problems following surgery, injury or fracture in the past 4 months? ______ Ulcer or ulcer surgery?
______ Raynaud’s syndrome?
______ Vertigo/dizziness?
______ Cancer in the past 6 months?
______ Your age is 60 or over to 69 ? (the maximum age limit for the tour is 69)

I fully understand the content of this form and the information I have provided about my medical history is accurate to the best of my knowledge. I agree to accept responsibility for omissions that are a result of my failure to disclose any existing or past medical health conditions.