IHMP First Aid

IHMP Medical

Health Declaration

Please fill out this form to participate in scuba diving activities or Certification Course Programs.

Personal Details

Instructor / Training Facility

Health Questions

Have you ever suffered from blackouts or mental illness?

Do you get or become out of breath from moderate exercise?

Are you suffering from or ever suffered from a medical condition, illness, or injury affecting your heart or lungs?

Are you a smoker?

Do you engage in any sports?

Do you drink more than 4 units of alcohol a day?

Can you swim for 30m / 100ft without any breathing difficulties?

Would you describe yourself as a "Fit & Healthy" person?

Do you consider yourself 'Overweight' for your height / age or BMI Index?

Emergency Contact & Notes

Declaration

Verification Data Consent & Release

I, the undersigned certification holder, hereby grant ITDA-IHMP International express and informed permission to publish my photograph, full name, date of birth, and certification level(s) on the ITDA-IHMP public verification register (itda-member.org/verify).

Purpose: This information is published so that third parties — including dive centres, equipment hire facilities, guided tour operators, employers, and other verification parties — can confirm my certification status and identity, as required by industry safety standards and age-restricted activity regulations.

What is published: My photograph (passport-style), full legal name, date of birth, certification level, issue and expiry dates, certifying instructor name, and training facility.

Who can access it: Any member of the public who searches by my name or scans the QR code printed on my certification card. Full identity details (photo, date of birth) are displayed when a verification is accessed via my ITDA Number or QR code. For anonymous name searches, full identity details are shown only if I have granted this consent; otherwise, name and certification level are shown with a notice directing the verifier to use my ITDA Number or QR code.

Right to withdraw: I understand I may withdraw this consent at any time by contacting ITDA-IHMP HQ, and my personal identity details (photo, date of birth) will be withheld from anonymous name searches. Withdrawal does not affect the validity of my certification.

Data retention: My certification data is retained for the duration of my active certification and the standard archival period thereafter, in accordance with the ITDA-IHMP Privacy Policy and GDPR.