Diving Course Inquiry Form

First Name

Last Name

Date of Birth

Email Address

Phone Number

Street Address

City

State/Province

Postal/Zip Code

Emergency Contact Name

Emergency Contact Phone Number

Have you ever dived before?

If yes, what certifications do you hold? (e.g., Open Water Diver, Advanced Open Water Diver, Rescue Diver, etc.)

Certifying Agency

Date of Last Dive

Number of Dives Logged

What is your comfort level in the water?

Are you comfortable swimming?

Can you tread water for 10 minutes?

Do you have any experience with snorkeling?

Beginner Courses

Continuing Education Courses

Please specify (e.g., Deep Diving, Night Diving, Wreck Diving, Underwater Photography, Enriched Air Nitrox, etc.)

Professional Courses

Please specify desired level

Other Interests

Medical Conditions: Do you have any medical conditions that might affect your ability to dive? (e.g., heart conditions, lung problems, epilepsy, diabetes, recent surgeries, etc.)

If yes, please provide details

Medications: Are you currently taking any medications?

If yes, please provide details

Physical Limitations: Do you have any physical limitations that might affect your ability to dive? (e.g., back problems, joint problems, etc.)

If yes, please provide details

Claustrophobia/Anxiety: Do you experience claustrophobia or anxiety in enclosed spaces?

If yes, please provide details

Ear Problems: Do you have a history of ear problems or difficulty equalizing pressure in your ears?

If yes, please provide details.

Swimming Ability: While being a strong swimmer isn't always essential for all courses, some level of comfort in the water is important. Please describe your swimming ability.

Availability: When are you available to take a course?

Please specify the specific date and time.

Budget: Do you have a budget in mind for your diving education?

If yes, please provide a range.

Please let us know if you have any other questions or require further information.

How did you hear about us?