Diving Course Inquiry Form


Thank you for your interest in our diving courses! Please fill out this form to help us understand your needs and recommend the best course for you.


Personal Information


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


Diving Experience


Have you ever dived before?



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?


Course Interest


Beginner Courses


Continuing Education Courses


Professional Courses


Other Interests


Course Suitability Questions


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.)


Medications: Are you currently taking any medications?


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


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


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


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?


Additional Information


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


How did you hear about us?


By submitting this form, you acknowledge that you have answered the questions truthfully and to the best of your knowledge. This information will be kept confidential and used only to assess your suitability for diving courses.


We look forward to hearing from you and helping you start your underwater adventure!


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