Scuba Refresher - Registration Request

Registration for Scuba Refresher

Scuba Refresher - Space is Limited - Minimum Age 10 yrs
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
My Diving History(Check one)
We will contact you during business hours to schedule your Private Comprehensive Scuba Refresher. (Longer than 5 years since scuba diving)

As a reminder details on course requirements for our Comprehensive Scuba Refresher / ReActivate Scuba Refresher can be found on our website: https://www.aquaticrealmscuba.com/classes_scubarefreshers.html#Comprehensive_Scuba_Refresher

You have access to the required release forms, including a Medical Statement Release form for the PADI ReActivate Scuba Refresher program. https://www.aquaticrealmscuba.com/release_forms/forms-compscuba-refrsh_reactivate.pdf

Thank-you for inquiry, we look forward to talking to you soon!
Scuba Refresher 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.
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.

Medical Release Form

You will be required to complete a Release Form 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 understand that I must have 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 confirm that I understand the Requirements of the Medical Release Form
I have read and agree to the terms and conditions
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Registration for Scuba Refresher