PADI Open Water Diver - Registration for Confined (pool) Session

Registration for Confined (Pool) Session: Space Limited

PADI Open Water Diver
Which option are you planning in enrolling in, for training. (Select one)*

I plan on choosing the Referral Package payment option.I plan on choosing the Complete Certification Package payment option.I plan on choosing the Pay as you go payment option.
Student Name*

First NameLast Name
Student Birth Date*

MonthDayYear
Name of Parent/Guardian if applicable.

First NameLast Name
Billing Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Student E-mail*
example@example.com
Phone Number*

Area CodePhone Number
Is Contact Phone Number your Cell Phone or Home Phone*
Select if this is a cell phone or home phone
Open Water Pool Training Dates*
Select Course Date from Drop Down Above.
Note: Enrollment closes 3 days prior to start of class.

All Classes have a minimum and maximum number of participants.
Terms and Conditions

You will be contacted during business hours to arrange payment. Registration will remain valid for 72 hours from receipt of email. If course isn't paid for by that time your registration will be removed.

I understand that I must have completed the online course with Aquatic Realm as my dive shop, completed all required release forms and made full payment before attending this pool session. I also understand that there are fees and possible forfeit of payment if class not attended.
I have read and agree to the terms and conditions*

Yes
Should be Empty:

Registration for Confined (Pool) Session: Space Limited