Check-in Form

Welcome and thank you for choosing Scuba Republic! Please complete all fields of our check-in form so we are better prepared for your trip.


PERSONAL INFORMATION
Name *
Email *
Date of Birth*
Phone
Gender
Passport Number*
Nationality of Passport*
TRIP INFORMATION
Invoice Number*
Booking Number*
Trip Date*
Arrival Date*
Packages*
Location to Meet Us*
Marine Park Pass & Fees*
Location to Meet Us*
Marine Park Pass & Fees*
Location to Meet Us*
Marine Park Pass & Fees*
Location to Meet Us*
Marine Park Pass & Fees*
DIVE EQUIPMENT
Please tell us about your equipment rental needs.
BCD
Regulator
Wetsuit
Mask
Dive Computer
Fins
Boots
Torch
EMERGENCY INFORMATION
Emergency Contact Name*
Email*
Phone*
Relation to Emergency Contact*
INSURANCE INFORMATION
Insurance Company
Policy Number
Insurance Company Contact Number
DIVER INFORMATION
How many dives do you have?*
When was your last dive?*
What is your certification level?*
MEDICAL INFORMATION
Have you ever had asthma?*
Do you have any heart conditions?*
Do you have diabetes or other endocrinal maladies?*
Do you have epilepsy or any other conditions that affect your consciousness / attention?*
Are you suffering from high blood pressure?*
Are you currently on any medication?* (except anti-malaria or anti-conception medication)?
Are you medically fit to dive/snorkel?*
OTHER INFORMATION
Vegetarian / allergies / special food request *
Additional notes *
How did you hear about us?
Your Passport Image (jpg, JPG, PNG < 10MB)