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Check In Form

PERSONAL INFORMATION
Name *
Email *
Date of Birth*
Phone
Gender
Passport Number*
Nationality of Passport*
TRIP INFORMATION
Invoice Number
Booking Number
Trip Date*
Trip*
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?* Open Water Diver (or equivalent)Advanced Open Water Diver (or equivalent)Rescue Diver (or equivalent)Divemaster / Dive Instructor or above (or equivalent)Snorkeler
MEDICAL INFORMATION
Have you ever had asthma?* YesNo
Do you have any heart conditions?* YesNo
Do you have diabetes or other endocrinal maladies?* YesNo
Do you have epilepsy or any other conditions that affect your consciousness / attention?* YesNo
Are you suffering from high blood pressure?* YesNo
Are you currently on any medication?* (except anti-malaria or anti-conception medication)? YesNo
Are you medically fit to dive/snorkel?* YesNo
OTHER INFORMATION
Vegetarian / allergies / special food request
Additional notes
How did you hear about us?
Image of Your Passport Information Page (JPG Only < 10MB)

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