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Diving Course Booking Enquiry

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DIVING COURSE APPLICATION FORM
PERSONAL INFORMATION
First Name
Last Name
Nationality
Gendermale/female
Date of Birth
Passport Number
Phone Number
EMERGENCY CONTACT DETAILS
Name
Relationship
Home Phone
Mobile Phone
DIVING DETAILS
Certification Level
Certification Agency
Number of Dives
Date of Last Dive
Prior DCS
INSURANCE DETAILS
Do you have dive insurance?
If yes please provide number
Do you need dive insurance?
EQUIPMENT INFORMATION
Do you want to rent diving equipment?
* If “yes” please provide the following sizes:
BCD
Wetsuit
Fins
Regulator
Mask
* If you are unsure about sizing please state your:
Weight
Height
Shoe Size
Do you need a DIN?
Do you want to rent a Dive Computer?
Courses (optional)
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