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TRIP LIABILITY FORM
TRIP RESERVATION FORM
About Us
Bluewater Scuba Trip Reservation Form
Name of Trip
*
Date of Trip
*
Full Name on Passport
*
Last, First, Middle
Passport Number
*
Passport Expiration Date
*
Date of Birth
*
Address
*
Mailing Address, City, State, Zip
Best Contact Phone
*
Email
*
Diver Agency
*
PADI
SSI
NAUI
Other
Certification Level
*
Open Water
Advanced
Rescue
Master Scuba Diver
Professional
Approx. # of Dives
*
4-20
20-40
40-100
Over 100
Over 500
Rooming Situation
*
FEMALE ROOMMATE REQUESTED
MALE ROOMMATE REQUESTED
ANY GENDER ROOMMATE REQUESTED
SINGLE OCCUPANCY REQUESTED
SMOKER
Do you have dive insurance?
*
Yes
No, please send info
Dive Insurance Company
*
Member #
*
Medical History
*
Do you have any medical history, medical condition, or physical impairment that would make traveling or diving related activities dangerous, hazardous, or expose you to exceptional risk? If "yes", please explain:
Emergency Contact
*
Emergency Contact Phone
*
What rental equipment, if any, will you need
*
BC
Regulators
Computer/Gauges
Training
*
Is there any specific training you would like to do on the trip or in preparation for the trip? If so, which courses?
Note: All trip quotes are based on cash prices. Booking fees may apply for payments by credit card. Due to fluctuations in airfares, fuel charges, taxes, etc., no trip quote can be guaranteed. Any changes by the customer in dates, accommodations, flights, or other aspects of the trip can affect the trip price and/or result in added administrative charges.
*
I acknowledge the statement above
Bluewater Scuba trip payments are all non-refundable, non-cancellable, and non-transferrable. To protect yourself against pre-trip cancellation or trip travel emergencies, we strongly recommend you purchase Trip Cancellation Insurance. A policy description and price quote is available at Bluewater Scuba or online through a link in the travel section of our website.
*
I have received information about Trip Cancellation Insurance
Submit
Trip Liability Form
File Size:
27 kb
File Type:
pdf
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