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To save time at check in - Please print out this application - Answer the questions and bring it with you. PAPA HOG'S SCUBA EMPORIUM - DIVING APPLICATION Personal Information Name____________________________________________________Age_____Male___ Female___ Home Address____________________________________________City______________________ State/Province___________________Country_____________Zip__________Phone______________ Hotel_______________________________Room#___________Check Out Date_________________ Airline_________________________________________________Departure Time_______________ Diving Information Are you certified?_________Agency__________________Certification Level?____________________ When was your last dive?_______________Total # of dives___________Maximum Depth___________ # of Ocean dives__________#Boat__________#Wall_________#Drift__________#Night___________ Name and address of local store________________________________________________________ General Information Have you ever had decompression sickeness before?________________________________________ If so, please give details________________________________________________________________ Do you feel confident and ready to dive?____________How many days of diving__________________ How did you hear about us?_____________________________________________________________ Would you like to rent a camera?____________Would you like to have a video made?______________ STATEMENT OF UNDERSTANDING AND WAIVER I am aware of the inherent hazards of SCUBA DIVING and agree that I should: Be in good mental and physical condition for diving. Avoid being under the influence of alcohol or drugs when diving. Engage only in diving actvities consistent with my training and experience. Listen carefully to dive briefings. Respect the advice of the Dive Master supervising my diving. Adhere to the buddy system throughout the dive. Never exceed depth or time limitations planned by the Dive Master. Maintain proper buoyancy control when diving and protect the reef ecology. I, ___________________________________have read and do fully understand all the above stated information. It is my intention to exempt and release Papa Hog's Scuba Emporium and it's agents from all liability whatsoever for personal injury, property loss, damage or wrongful death. Signature of Client____________________________________________Dated____________________ THANK YOU FOR YOUR PATIENCE IN COMPLETING THIS FORM |