DIVER PROFILE FORM
 

 

Trip Details
Departure Date Return Date Trip Reference
Passenger Details
Name Date of Birth
Permanent Address City
State Post Code
Country Gender Male Female
Phone Email
Dive Qualifications & Experience
Certification Agency Certification No

Certification Level:
(Open Water/Advanced etc)
Number of dives Date of last dive    
Nitrox Certification Level (if applicable)

Nitrox Certification Agency (if applicable e.g TDI, PADI)
Other Information
Do you have any special dietary requirements?
(allergies, vegetarian. etc)		 Details:
Do you have any medical conditions
(such as epilepsy/asthma/diabetes/decompression sickness /allergies, etc)
that are relevant to diving, that we should be aware of?
 		 YES NO
If yes please provide details:

If “yes” we require a letter from a Doctor trained in diving medicine stating that you are fit to scuba dive with your condition.
Emergency Contact
Name:  Relationship: Email:
Address Phone:
Dive Requirements
   I am bringing my own dive gear
or

If you require gear hire please tick the items and size required:
Full Set Gear Inc. Computer XS S M L XL XXL XXXL
or  
Wetsuit XS S M L XL XXL XXXL
B.C.D. XS S M L XL XXL XXXL
Regulator & Computer  
Mask / Fins / Snorkel Foot size:
Computer Only Dive Computer are compulsory on all trips
Torch Torch not included in Full Set of gear
Please Note: The Great Barrier Reef Marine Park Authority collects an environmental management charge of $16.50 per visitor to the Marine Park and in some cases fuel and port levies apply.
 
I have Diving insurance?
Insurance
Membership No.		 Insurance
Organisation:		 Insurance
Contact Phone:

 

 

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