Diver Registration Form

1

Diver Registration Form

Before you start, please read and understand the LIRS Diver Induction Package.

The supporting documents required are listed on the next slide. They should be scanned and ready to upload before you begin.

If you don't yet have some of the supporting documents (e.g. current diving medical), you may submit the form without uploading them but they must be provided before you will be allowed to dive at LIRS. The exception is the dive log - you must provide that information here. If you do additional dives before coming to LIRS, the file can be updated.

All questions other than some upload fields must be answered. Partially completed forms cannot be saved. No information is sent to us until you click on 'Submit' at the end of the form.

Your personal information will be handled according to the Australian Museum's privacy policy.
2
Supporting documents

The following documents must be uploaded separately through this form. Pdf format is preferred but jpg is acceptable, as is xlsx for dive logs only. Do not use any other format.

Divers new to to LIRS and those who have not dived at LIRS in the past three years:

Highest diver certification (both sides, if a card)

Current AS2299 dive medical or overseas equivalent

Current first aid certificate

Current advanced resuscitation certificate (CPR with oxygen)

The most recent 60 hours in your logbook (or all dives, if fewer)

Divers who have dived at LIRS within the past three years:

New diver certification card (if upgraded since last visit)

New medical, first aid or advanced resus certificates (if expired since last visit)

The six most recent dives in your logbook (more may be needed)

Boat drivers:

Boat licence that is acceptable in Queensland (both sides, if a card)
3
Your name* This field is required.
First Name
Last Name
4
When are you going to LIRS?* This field is required.This must be a date in the future.
Date
Day
Month
Year
5
Your nationality* This field is required.
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
6
Your university or institution* This field is required.
7
Your email* This field is required.
example@example.com
8
Your phone number* This field is required.Australia's country code is +61.
Country Code
Area Code
Phone Number
9
Your home address* This field is required.Include country if not Australia
10
Emergency contact* This field is required.Your emergency contact should be someone who is not at Lizard Island with you.
Your emergency contact's name
Please Select
Please Select
Spouse/partner
Parent
Daughter/son
Sibling
Other family member
Friend
Relationship to you
Your emergency contact's phone number
Your emergency contact's email or second way of contacting them.
11
We need the following medical information about you.
12
Your date of birth* This field is required.This is required by medical authorities in case of emergency.
Date
Day
Month
Year
13
Are you allergic to any medications?* This field is required.
YesNo
14
Medication allergies* This field is required.Please provide details.
15
Do you have any other allergies?* This field is required.e.g. to foods or substances.
YesNo
16
Other allergies* This field is required.Please provide details including any action plan and/or medication carried for it.
17
Do you take any medications regularly?
YesNo
18
Regular medications* This field is required.Please provide details of your regular medications.
19
Do you have any medical conditions that may be affected by diving that are not noted on your current diving medical certificate?* This field is required.
YesNo
20
Medical conditions relevant to diving not noted on current diving medical certificate* This field is required.Please provide details of the medical condition..
21
Now we're up to your diving and boating qualifications and experience.
22
What is your highest diver qualification?* This field is required.Please select one
Commercial or scientific diver training
Divemaster or higher-level recreational training
Recreational rescue diver training
Recreational training below rescue-level
23
When was your most recent AS2299 diving medical certificate issued? * This field is required.The certificate must be uploaded at the end of this form. This must be a date in the past. If you don't yet have a current dive medical, enter 01-01-1901. The certificate must be provided before you will be allowed to dive at LIRS.
Date
Day
Month
Year
24
When was your most recent First Aid certificate issued?* This field is required.This refers to a general First Aid certificate, which must be uploaded at the end of this form. Advanced Resuscitation (CPR with use of medical oxygen) is a different course and a different certificate, not relevant to this question. This must be a date in the past. If you don't yet have a current first aid certificate, enter 01-01-1901. The certificate must be provided before you will be allowed to dive at LIRS.
Date
Day
Month
Year
25
When was your most recent Advanced Resuscitation certificate issued?* This field is required.This is usually a separate course to a general First Aid course. It includes CPR with use of medical oxygen. The certificate must be uploaded at the end of this form. This must be a date in the past. If you don't yet have a current Advanced Resus certificate, enter 01-01-1901. The certificate must be provided before you will be allowed to dive at LIRS.
Date
Day
Month
Year
26
How many dives have you logged after your initial certification?* This field is required.Exclude dives done as part of an open water course. You will need to provide proof of your diving experience at the end of this form
27
How many hours have you logged after your initial certification?* This field is required.Exclude dives done as part of an open water course. You will need to provide proof of your diving experience at the end of this form.
28
What is the date of your most recent dive?* This field is required.
Date
Day
Month
Year
29
Have you logged four or more dives in the past 12 months?* This field is required.This allows us to gauge your recent diving experience. All divers at LIRS other than Restricted Divers must have logged - at least four dives within the past 12 months, or - at least six dives within the past 18 months including at least one within the past six months. We'll contact you for more information if you answer No to this question.
YesNo
30
Please indicate if you have more than 5 hours diving experience in any of the following activities:* This field is required.Select all that apply.
Coral reef diving
Diving from small boats (roll-in entry)
Recording data underwater
Laying transect lines
Collecting specimens using barrier nets
Collecting specimens using spearguns
Using hand tools underwater
Using air-powered tools underwater
Underwater photography/ videography
Using lift bags
Night diving
Blue water diving (i.e. midwater, cannot see the bottom)
Cave diving
Diving deeper than 25 metres
I don''t have 5 hours experience in any of these diving activities
31
Do you hold a boat licence that is acceptable for driving a recreational or commercial vessel in Queensland?* This field is required.That includes boat licences issued by any Australian state and specific overseas licences. LIRS can provide a list of acceptable overseas licences.
YesNo
32
Indicate if you have more than 20 days experience driving boats as listed below within the last five years (not as a passenger)* This field is required.Select all that apply.
Small, tiller-steered outboard boats
Wheel-steered power boats
Any kind of boat in coral reef areas
In enclosed waters (lakes, rivers, harbours)
In coastal waters up to 2 km from shore
In coastal waters up to 30 km from shore
In oceanic waters more than 30 km from shore
I have fewer than 20 days experience driving boat in the past five years
33
Please upload your highest diver qualification.If it's a card, please make sure both sides are in the same file. Use pdf or jpg format. No need to upload it if you have dived at LIRS within the past three years.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
34
Please upload your diving medical certificate.We just need the letter from the doctor, not the multi-page medical exam form. Use pdf or jpg format. No need to upload it if LIRS already has your current certificate on file.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
35
Please upload your First Aid certificate.This refers to a general First Aid certificate, not one for resuscitation with use of medical oxygen. Australian First Aid certificates are valid for three years. Please do not upload your Advanced Resuscitation certificate here - that comes next. Use pdf or jpg format. No need to upload it if LIRS already has your current First Aid certificate on file.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
36
Please upload your Advanced Resuscitation certificate.This refers to a course about resuscitation with use of medical oxygen. Australian Advanced Resus certificates are valid for one year. Please do not upload your First Aid certificate here - that is at the previous step. Use pdf or jpg format. No need to upload it if LIRS already has your current Advanced Resus certificate on file.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
37
Please upload relevant dive log entries.* This field is required.Divers new to LIRS must provide the most recent 60 hours, or entire diving history if less than 60 hours. Divers who have dived at LIRS within the past three years must provide details of their six most recent dives.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
38
If you have a boat licence and want to drive a boat at LIRS, please upload the licence here.Use pdf or jpg format. If it is part of your driver's licence, show both sides of the card.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
39
All diving teams must submit a Dive Plan. This can be done using the template provided in the Diver Induction Package or using the team's institutional template. Are you the team member responsible for submitting a Dive Plan (usually done by the Project Lead)?* This field is required.
YESNO
40
Dive Plan Submission* This field is required.Please submit the Dive Plan for your team
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
41
You must accept the statements below to register as a diver at LIRS* This field is required.1. The information I have provided is true to the best of my knowledge. 2. The regulator, gauges and BCD that I will be using at LIRS have been serviced within the past 12 months and are in good working order. (If you are hiring these things from LIRS, they will be). 3. I have read and understood the LIRS Diving Regulations and agree to abide by them. 4. I understand the roles and duties of dive team members (Dive Coordinator, Dive Leader, Diver, Boat Attendant) and I agree to fulfill my responsibilities as assigned. 5. I will ensure that I understand the dive plan and risk assessment(s) for my dive team (and any other dive team that I might join while at LIRS) and I will abide by the plan(s) and implement the risk control measures.
I acceptI do not accept
42
You must accept the statements on the previous screen to register as a diver at LIRS.

You can go back and change your choice before submitting.
43
Should be Empty: