Beyond Blue Registration Form

Beyond Blue 2025 Registration Form
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Emergency Contact (Name & Number)*
Do you have any dietary restrictions?*

YesNo
If yes, please specify
Do you have any medical conditions or accessibility needs we should be aware of?*

YesNo
If yes, please specify
SECTION 2: DIVING & PROFESSIONAL BACKGROUND
Diving Certification Level (tick one)*

Open WaterAdvanced Open WaterRescue DiverDivemasterInstructorOther
Certifying Agency (select one)*

PADISSINAUICMASOther
Years of diving experience*

Less than 1 year1-3 years3-5 years5+ years
Upload Valid Certification

Cancelof
SECTION 3: CONSENT & DECLARATION
Please tick to confirm*

I am medically fit for scuba diving or will present a medical clearance if required.I acknowledge diving involves risk and I will comply with all safety protocols.I consent to the use of photographs or video in which I may appear for promotional or educational purposes.I agree to sign the participant waiver upon confirmation of my place.
Electronic Signature Consent
By typing my name below and clicking “Submit,” I agree that:
- I have read, understood, and accept the terms of this waiver and registration.
- I understand that this typed name is legally binding and serves as my electronic signature.
- I am voluntarily participating in the Beyond Blue event and accept all associated risks as described above.
Full Name:*
Date*

MonthDayYear
Date
Clicking Submit will save your registration and automatically redirect you to our secure Kwiq Pass payment page.
Your registration is only complete after payment.
If you are not redirected, check your confirmation email for the payment link.
Should be Empty:

Beyond Blue 2025 Registration Form

SECTION 2: DIVING & PROFESSIONAL BACKGROUND

SECTION 3: CONSENT & DECLARATION