Scuba Diving Course Application Form

  • Please fill all the box with pink frame. It is required information.
  • You may not fill "Name (Th)" if you do not have one.
  • Please use the address that we can contact or post documents to you, not necessary to be legal residence.
  • In case you are not living in Thailand, please specify your country in the box "City, Country".
  • You can easily move to the next box with the button [Tab] on your keyboard.

Personal Information

Course Arrangement Information

I understand that in the case my course does fail or take longer time and more resources due to my physical or psychological conditions, the shop may request a reasonable surcharge to me as for operate the course as fun, safe, and successful to me.

I have never had or been with these symtoms or diseases;
- High blood pressure
- Respiratory diseases
- Ear problems
- Spinal problems 		- Stroke, Heart disease
- Diabetes
- Sinusitis
- Unconciousness from vicious impact on head or brain within the last 5 years
- Incapable to do little exercises such as walking 1.6 km within 12 minutes

Health Information

Diving Information