Please enable JavaScript in your browser to complete this form.Anticipated Start Date of Cruise: *What is your age? *18-2425-3435-4445-5455-6465-7475-8485+ Some underlying medical conditions INCREASE the risk of a person getting COVID-19. Do you have any of the following conditions? Cancer Chronic kidney diseaseCOPDImmunocompromised state (weakened immune system) from solid organ transplantObesity (BMI of 30 or higher) Serious heart conditions (heart failure, coronary artery disease, or cardiomyopathies)Sickle cell diseaseType 2 Diabetes https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fgroups-at-higher-risk.htmlOther underlying medical condition(s): Some chronic medical conditions MIGHT put COVID-19 patients at higher risk. Do you have any of the following chronic medical conditions?Asthma (moderate to severe)Cerebrovascular disease (affects blood vessels and blood supply to the brain) Cystic fibrosis Hypertension or high blood pressureLiver diseaseKidney failure that requires dialysisThalassemia (blood disorder)Neurological conditions (eg. dementia)Pulmonary fibrosisPregnancyImmunocompromised state (weakened immune system)Other chronic medical condition(s)Have you experienced any of these symptoms in the past 24 hours? *Fever (or feeling feverish) Shortness of breathCoughBody achesLoss of smell and/or tasteSore throatNone of the above Have you ever been diagnosed with COVID-19? *Yes NoDoes your role on this cruise include SCUBA? *YesNoHave you been medically cleared to SCUBA? YesNoHave you TRAVELED to an area designated by the CDC as a Level II (or higher) area in the past 14 days? *YesNohttps://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.htmlIn the past 14 days, have you had close contact with someone who is diagnosed with COVID-19? *Yes NoA close contact is defined as a person who: provided care for the individual, including healthcare workers, family members or other caregivers, or who had other similar close physical contact without consistent and appropriate use of personal protective equipment OR who lived with or otherwise had close prolonged contact (within 6 feet) with the person while they were infectious OR had direct contact with infectious bodily fluids of the person (e.g. was coughed or sneezed on) while not wearing recommended personal protective equipmentHow would you rate your overall satisfaction with how FIO is handling COVID-19? Very satisfiedSomewhat satisfiedNeither satisfied nor dissatisfied Somewhat dissatisfiedVery dissatisfiedFirst and last name: *Email *PhoneSubmit