PADI Dive Course Form

PADI Dive Course Form - Spring 2025

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 Ali at amroberts@hpu.edu.

Name Name First Last
Email
Date of Birth Date of Birth / MM / DD YYYY
Date Preference
Select one of the following options for class dates:

Option 1
Thursday, January 23rd --- 6 pm Classroom Session
Saturday, January 25th --- 4 pm Pool Session
Saturday, February 1st --- 4:30 pm Pool Session
Saturday, February 15th --- 4:30 pm Pool Session
Saturday, February 22nd --- Early morning Shore Dives
Sunday, February 23rd --- Early afternoon Boat Dives

Option 2
Thursday, March 13th --- 6 pm Classroom Session
Saturday, March 15th --- 4 pm Pool Session
Saturday, March 22nd --- 4:30 pm Pool Session
Saturday, March 29th --- 4:30 pm Pool Session
Saturday, April 5th --- Early morning Shore Dives
Sunday, April 6th --- Early afternoon Boat Dives

**Keep in mind the meeting times will be slightly earlier to accommodate for transportation time.**

Date Preference
Select one of the following options for class dates:

Option 1
Thursday, January 23rd --- 6 pm Classroom Session
Saturday, January 25th --- 4 pm Pool Session
Saturday, February 1st --- 4:30 pm Pool Session
Saturday, February 15th --- 4:30 pm Pool Session
Saturday, February 22nd --- Early morning Shore Dives
Sunday, February 23rd --- Early afternoon Boat Dives

Option 2
Thursday, March 13th --- 6 pm Classroom Session
Saturday, March 15th --- 4 pm Pool Session
Saturday, March 22nd --- 4:30 pm Pool Session
Saturday, March 29th --- 4:30 pm Pool Session
Saturday, April 5th --- Early morning Shore Dives
Sunday, April 6th --- Early afternoon Boat Dives

**Keep in mind the meeting times will be slightly earlier to accommodate for transportation time.** Option 1 Option 2
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 - Spring 2025

PADI Dive Course Form - Spring 2025

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