Discover Scuba Diving - Registration Request

Registration for Discover Scuba Diving

Discover Scuba Diving - Space is Limited - Minimum Age 10 yrs
What is your status with your enrollment in PADI Discover Scuba Diving eLearning Course (Select one)*

I am enrolled and have/will complete the online academics with Aquatic Realm as my dive shop before this pool session.I plan on enrolling and completing the online academics with Aquatic Realm before the pool session.
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
Discover Scuba Diving Course 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.
Medical Release Form

You will be required to complete a Release Form online with a medical statement before any inwater training. This information is confidential and, because it identifies medical conditions that may be affected by diving, it is vital that you complete it accurately. If any of the conditions apply to you, you will need to consult with a physician and receive a non-conditional physician approval before any inwater training. If you require non-conditional physician approval for diving, you will need to print the medical statement (3 pages) complete it and take it to your physician for non-conditional physician approval. Then return all (3 pages) back to the dive center.

Click to Preview Medical Statement for more information before enrolling
I confirm that I understand the Requirements of the Medical Release Form*

Yes
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
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Registration for Discover Scuba Diving