Independent Snorkeller Form

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

If you want to drive a boat at LIRS, you will need to have your boat licence scanned (both sides if a card) and ready to upload.

All questions must be answered. No information is sent to LIRS 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.
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Your name* This field is required.
First Name
Last Name
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When are you going to LIRS?* This field is required.
Date
Day
Month
Year
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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
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Your university or institution* This field is required.
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Your contact details* This field is required.
Email
Phone, includinng country and area codes
Home address
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Your date of birth* This field is required.
Date
Day
Month
Year
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Your emergency contact* This field is required.This is the person we will contact in case of emercency. It should be someone who is not at Lizard Island with you.
Full name of your emergency contact person
Please Select
Please Select
Spouse/partner
Parent
Daughter/son
Sibling
Other family member
Friend
Relationship to you
Best contact for your emergency person - enter phone including all codes or email address
Secondary contact for your emergency person
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Are you bringing your own child or children on this trip? * This field is required.If YES, we will contact you for more information.
YESNO
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Do you have a medical condition that can be made worse by physical exertion or brought on by cold water or salt water mist?* This field is required.Examples include heart disease, asthma, some lung complaints.
YESNO
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Do you have a medical condition that can result in loss of consciousness?* This field is required.Examples are some forms of epilepsy, some diabetic conditions
YESNO
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What is/are your medical condition(s)?
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Are you taking any prescribed medications?* This field is required.
YESNO
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List your prescribed medications* This field is required.
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Are you allergic to any medications, organisms or substances?* This field is required.
YESNO
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List your allergies.* This field is required.
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What is your level of physical fitness for your age?* This field is required.
Good
Average
Poor
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Can you swim 100 metres in a pool?* This field is required.
Easily
With difficulty
No
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Can you float on your back for five minutes?* This field is required.
Easily
With difficulty
No
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Can you tread water for five minutes?* This field is required.
Easily
With difficulty
No
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What is your level of snorkelling experience?* This field is required.
High
Medium
Low
None
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How often have you snorkelled without supervision?* This field is required.
Often
Rarely
Never
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If you have a boat licence and want to drive a boat at LIRS, please upload the licence here.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Briefly outline your boat driving experience.* This field is required.E.g.: I have owned a 4.5 m tinny with 30 hp outboard for 10 years and use it regularly on Lake Tinaroo, or I have had a boat licence for years but have rarely driven a boat since about 2015. If you have been approved to drive a boat at LIRS in the past, no need to go into details - just state that.
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Swimming ability* This field is required.1. I am a CONFIDENT SWIMMER and I accept responsibility for my own safety while undertaking snorkelling and boating activities. 2. I am NOT CONFIDENT to swim alone but I am confident to undertake snorkelling and boating activities when accompanied by the person I will nominate (on the next screen), and I accept responsibility for my own safety while conducting those activities.
1. Confident swimmer
2. Not confident to swim alone
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Name of the person with whom you are confident to snorkel on this trip.* This field is required.Only required for people who are not confident to swim alone.
First Name
Last Name
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Independent Snorkeller's statementsPlease indicate whether or not your accept ALL of the following statements: 1. I have read the LIRS Independent Snorkelling Induction Package and will follow the procedures for snorkelling (and boating, if applicable) detailed in it. 2. I have read and understood the LIRS document Risk Assessment for Independent Snorkelling. 3. All or most of the hazards involved in my planned boating, snorkelling and swimming activities are identified in the LIRS Risk Assessment for Independent Snorkelling and I consider that the control measures listed are adequate and appropriate for the perceived risks. I will submit an additional risk assessment for any hazards that I consider are not adequately covered. 4. I will implement the control measures identified in the Risk Assessment for Independent Snorkelling (and any additional risk assessments, if completed) to reduce the risks to an acceptable level. 5. I understand the risks inherent in the snorkelling and boating activities that I plan to carry out while staying at LIRS and that my participation may result in my death or serious injury. I understand that the risks include drowning, injuries caused by vessels and other perils of the sea including marine life. I knowingly and voluntarily agree to accept these risks. 6. I believe that my level of fitness is adequate for undertaking my planned field activities and I will not overexert myself. 7. I authorise any relevant medical treatment as a result of any injury I may suffer during these activities and I understand that I will be responsible for all costs associated with that medical treatment. 8. I understand that snorkelling can be a strenuous physical activity even in calm water and that older persons are at an increased risk of death and injury due to a higher incidence of medical conditions made worse by physical exertion, such as heart disease and stroke. 9. I will inform the LIRS Dive Officer if I have any concerns about a medical condition affecting my ability to snorkel safely and I will not enter the water until those concerns have been addressed. 10. I will reassess environmental conditions and other hazards prior to each snorkelling activity and I will not undertake the activity if the level of risk is unacceptable to me. 11. I will NOT use a weight belt unless I have obtained approval from the LIRS Dive Officer. If I use a weight belt, I will ensure that I am correctly weighted and that the belt can be dropped easily in an emergency.
I accept all statementsI reject one or more statements
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