PADI Dive Course Form

PADI Dive Course Form - Fall 2024

This form is a requirement to participate in a PADI dive course. Please fill out the form to your best ability. If you have any questions please contact Dr. Clark at atclark@hpu.edu

Name Name First Last
Email
Date of Birth Date of Birth / MM / DD YYYY
Height (if wetsuit is needed)
Unless you own a wetsuit, please select one.

Height (if wetsuit is needed)
Unless you own a wetsuit, please select one. 5' (152cm) or Smaller 5'1" - 5'3" (153cm-160cm) 5'4" - 5'6" (161cm- 168cm) 5'7" - 5'9" (169cm-175cm) 5'10" - 6' (176cm-184cm) 6'1" - 6'3" (185cm-190cm) 6'4" (191cm) or greater
Weight (if BCD/regulator is needed)
Unless you own a BCD and regulator, please select one.

Weight (if BCD/regulator is needed)
Unless you own a BCD and regulator, please select one. 120 lbs or smaller (<54 kg) 121lbs - 150 lbs (55kg - 68kg) 151lbs - 180lbs (68kg - 81kg) 181lbs - 220lbs (82kg - 100kg) 221lbs - 285lbs (100kg - 130kg)
I am at least 10 years old
(If 10-17 years old, you must have a parent or guardian sign all required documents)

I am at least 10 years old
(If 10-17 years old, you must have a parent or guardian sign all required documents) Yes No
I am not flying within 24 hours of diving.
(This includes helicopter tours)

I am not flying within 24 hours of diving.
(This includes helicopter tours) Yes No
I am able to swim 200 yards continuously and tread water for 10 minutes.

I am able to swim 200 yards continuously and tread water for 10 minutes. Yes No
Please click on the image below to review the Padi Medical Questionnaire prior to answering the following question.
I have reviewed the PADI Medical Questionnaire and understand if I answered 'yes' to any question I must have a physician sign the statement prior to any in-water training.

I have reviewed the PADI Medical Questionnaire and understand if I answered 'yes' to any question I must have a physician sign the statement prior to any in-water training. Yes No
I will complete the PADI eLearning prior to my course date.

(The eLearning code will be emailed and can take 24-48 hours to arrive in your email. It takes approximately 12 hours to complete the eLearning PRIOR to starting the first day of class. Failure to complete this will result in a forfeiture of the class with no refund.)

I will complete the PADI eLearning prior to my course date.

(The eLearning code will be emailed and can take 24-48 hours to arrive in your email. It takes approximately 12 hours to complete the eLearning PRIOR to starting the first day of class. Failure to complete this will result in a forfeiture of the class with no refund.) Yes No
I understand once I receive the PADI eLearning code and open it, the eLearning fee becomes non-refundable.

I understand once I receive the PADI eLearning code and open it, the eLearning fee becomes non-refundable. Yes No

PADI Dive Course Form - Fall 2024

PADI Dive Course Form - Fall 2024

Please click on the image below to review the Padi Medical Questionnaire prior to answering the following question.