Dive Paradise Diving Form

Paraiso del Buceo, S.A. de C.V.

Your safety is our #1 concern.

Today's Date*

Hotel Name*

Room Number

Check-Out Date*

Personal Information (PLEASE PRINT CLEARLY)

Name*

First Last

Birthdate*

Occupation

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Are You Taking Any Medications?*

Yes
No

If yes, what medication?

Check if you have any health disorders which could present a problem while diving? If so, please give details on next section.*

Yes
No

Health details from previous question (If yes)

Diving Information

Are You A Certified Diver?*

Which agency is your certification with?*

Certification Number*

Highest Certification Level*

Number Of Dives*

Please upload a photo of your cert card if possible*

Max. file size: 20 MB.

Date of Last Dive*

What Was the Depth Of Your Deepest Dive Ever*

Which most closely identifies your level of diving expertise?*

Beginner
Intermediate
Advanced
Expert

Do you feel confident and ready to dive?*

Yes
No

If not, would you like to speak with one of our instructors?

Yes
No

Would you like to hire a private divemaster to assist you with your first day of boat diving?

Yes
No

Divemaster Preference? If so, with whom?

Buddy Preference?

Is this your first experience with Dive Paradise?

Yes
No

How did you hear about us?

Diving Equipment

(Belts and weights, only, are included on boat trips at no extra cost.)

Please select the equipment you will need.

BCD Size

Approx lbs of weight

Fin Size

Wet Suit Size (Shorty)

Other Needs. Please Specify

Special Interest Diving -

Some extra cost may be involved, and departure from one central location may be required

Please check any special trips in which youd like to participate if theyre offered during this or future visits to Cozumel

Statement of Understanding and Waiver

Statement of Understanding and Waiver I understand that I am responsible for loss of and/or damage to any and all equipment loaned or rented to me by Dive Paradise; and that it is my obligation to return this equipment only to the location from which I received it. I am aware of the inherent hazards of scuba diving and agree that I must: • Be in good mental and physical condition for diving and avoid being under the influence of alcohol or drugs when diving. • Engage only in diving activities consistent with my training and experience. • Listen carefully to dive briefings and respect the advice of the Divemasters supervising my diving activities. • Adhere to the buddy system throughout every dive. • Observe local diving laws which state specifically that nothing may be removed from the reefs within park boundaries. • Never exceed depth or time limitations planned by my Divemasters. • Maintain proper buoyancy control when diving and do my best to avoid causing damage to the fragile reef ecology.

I

Name*

First Last

have read and do fully understand all of the above stated information. It is my intention to exempt and release Paraiso de Buceo, S.A. de C.V. (Dive Paradise) and its agents from all liability whatsoever for personal injury, property loss or damage, or wrongful death.

Signature*