Alam Batu Guest Information Form

Alam Batu Guest Information Form

Please help us prepare for your arrival by completing this form. You will need copies of your passport and certification card (if you'll be diving). We look forward to welcoming you soon at Alam Batu!
Passport Information
Full name as it appears in your passport*

First NameMiddle NameLast NameSuffix
Country of Issue:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Passport Number:*
Expiration Date:*

MonthDayYear
There must be six months of validity remaining after your date of entry into Indonesia.
Passport Copy*

PDF, JPG, PNG or JPEG accepted (max 10MB)
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Your Contact Information
Email*

Confirmation Emailexample@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Country CodeArea CodePhone Number
Arrival Information
Date of Arrival at Alam Batu*

MonthDayYear
Date
Have you stayed with us before?*
Special Requests
Do you have any special dietary or other requests?*
Please list any special requests such as dietary requirements
Diving and Certification Information
Will you be diving with Alam Batu?*
Certification Agency*
Certification Number*
Are you Nitrox certified?*
Dive Insurance Provider*
All certified guests must possess valid diving insurance
Dive Insurance Policy Number*
Certification Card Copy*

JPG, JPEG, PDF and PNG accepted (max 10MB)
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Number of dives to date*
Do you have any medical conditions that may affect your ability to participate in snorkeling or diving?*
Medical conditions:*
If you have clearance from a medical professional for your condition(s) please upload it here.

PDF, DOC, DOCX, JPG, JPEG, or PNG accepted (Max 10MB)
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Will you require any rental equipment?*
ComputerBCDRegulatorMaskFinsWetsuit
BCD size*
Fin Size*
Wetsuit Size*
XS, S, M, L, XL, XXL and Mens/Womens
Emergency Contact Details

Please provide the contact details for someone that WILL NOT be at Alam Batu with you
Emergency Contact Name*

First NameLast Name
Relationship to you*
Emergency Contact Email*

Confirmation Emailexample@example.com
Emergency Contact Phone Number*

Country CodeArea CodePhone Number
Should be Empty:

Alam Batu Guest Information Form

Passport Information

Your Contact Information

Arrival Information

Special Requests

Diving and Certification Information

Emergency Contact Details