Student PADI Forms

STUDENT PADI FORMS

Student Information

Student Name:

Date of Birth: Day Month Year

Student ID / PADI # (if any):

Emergency & Medical Contacts

Course Selection & Scheduling

Select Course(s):

Open Water Diver    Advanced Open Water    Rescue Diver

Divemaster    Specialty (specify below)    EFR / First Aid

Preferred Start Date: Day Month Year

Payment option: Full payment on enrollment    Deposit    Payment plan (details below)

Medical History & Fitness to Dive

The following questions are required by the instructor and are material to safe participation in scuba training. Answering "Yes" requires physician clearance prior to participation.

Do you currently have, or have you ever had: (check any that apply)

Asthma or wheezing    Heart disease or heart attack    Seizures or fainting

Diabetes    Recent surgery or hospitalization    Pregnancy or trying to become pregnant

I certify that the information provided is complete and accurate to the best of my knowledge, and I acknowledge that failure to disclose a relevant medical condition may increase the risk of injury or death while participating in scuba training. I understand that if any medical conditions are indicated, I must obtain written clearance from a physician before participating in water activities.

Assumption of Risk, Release & Indemnification

I understand that scuba diving, snorkeling, and related classroom and pool activities involve inherent risks, including but not limited to drowning, decompression sickness, air embolism, barotrauma, hypothermia, injuries from marine life, slips and falls, and equipment failure. I knowingly and voluntarily assume all risks associated with participation.

In consideration of being permitted to participate, I release, waive and discharge the dive center, its owners, officers, instructors, employees, agents and affiliates from any and all liability, claims, demands, causes of action and costs (including attorneys' fees) arising out of or related to my participation, whether caused by ordinary negligence, the condition of facilities or equipment, or otherwise, except for conduct found to be grossly negligent or willful misconduct. I agree to indemnify and hold harmless the released parties from any claims, liabilities or expenses arising from my acts or omissions.

I authorize staff to arrange emergency medical treatment and transportation if necessary. I agree to pay all related costs and expenses for emergency medical treatment.

I have read, understand, and accept the Assumption of Risk, Release and Indemnification statement above, and I agree to abide by all instructor and dive center directions and safety procedures.

Equipment Rental Agreement

Rental Period: From Day Month Year To Day Month Year

I accept financial responsibility for loss, theft or damage to rented equipment and agree to pay repair or replacement costs. I understand failure to return rented equipment may result in additional charges.

Certification Card Information

Academic & Attendance Policies Acknowledgment

Students must complete all required knowledge development modules, pool sessions and open-water dives to meet certification standards. Failure to attend scheduled sessions may result in additional fees for rescheduling. Tuition payments do not guarantee certification; certification is issued only upon satisfactory completion of required skills and knowledge assessments.

I acknowledge and accept the academic and attendance policies described above.

Photograph & Media Release

I authorize the dive center and its representatives to photograph and record me during training and to use such images and recordings for instructional and promotional purposes without compensation. I understand media may be used in printed materials, presentations, and social media.

I consent to the use of photographs and media as described above.    I do not consent to media use.

Parent / Guardian Consent (If Student Is Under 18)

Minor status: Student is under 18 years of age    Student is 18 or older

If signing on behalf of a minor, I affirm that I am the parent or legal guardian of the student and have legal authority to consent to the student's participation. I agree to all terms, releases and indemnities contained in this document and authorize emergency medical treatment if required.

Acknowledgment & Certification

By signing below I certify that I have read and understand all sections of this consolidated Student PADI Forms package, that the statements made are truthful, and that I agree to be bound by the terms, acknowledgments and releases contained herein. I warrant that I am physically and mentally fit to participate, or that a physician's written clearance has been provided.

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