Diver Certification Form

Please complete a DIVER CERTIFICATION FORM for each member of your group interested in diving this trip. Please complete the form even if you are already certified. Each Diver will need a unique email address for the elearning component. Children must be 12 years old to participate in the Dive Certification Program. 10 & 11 year olds are admitted with the approval of the Course Director. Please Complete a DAGGER DIVE KID'S CAMP FORM for your non-divers age 11 and under. THANK YOU!

Service Members Name
Divers Name
Divers Date of Birth
MM slash DD slash YYYY
Divers Age
If under 18 Please complete the parent section.
Cell Phone
Divers Email

Must be their own email to receive online dive training.
Previous Dive Training
Certifying Agency
Certification Level
Date of last Dive
MM slash DD slash YYYY
Do you have your certification card
Max. file size: 50 MB.
If you have a certification card from previous training please attach it here.
Divers Shirt Size
Diver Shoe Size
Diver Height/Weight

Example: 72"/200Lbs
Are you bringing your own dive equipment?
Any medical issues or injuries?
Please complete if your diver is under 18
Parent Name
Parent Phone Number
Parent Email
Be sure to bring all your medications with you! Please note: All participants will be asked to sign a HIPPA Form and to provide a list of any medications being taken. This data will only be shared with the event physician and foundation administrators to ensure your safety and privacy.
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Phone
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Diver Certification Form

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