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)*

It has been Less than 5 years since I have been Scuba Diving.It has been Longer than 5 years since I have been Scuba Diving.
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, and the link for enrolling in the PADI ReActivate Scuba Refresher program.

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.

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 have read and agree to the terms and conditions*

Yes
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Registration for Scuba Refresher