POS Try/Scuba Review Reservation Form

PADI Discover Scuba:
Not sure if Scuba is for you?
Try a 30 minute pool session

PADI Reactivate/Refresher SCUBA Program:
ReActivate is the engaging, efficient way to refresh your scuba skills
* Move quickly through topics you know well
* Dive deeper on topics where your knowledge may have lapsed

PADI Discover Scuba: Most classes sell out, so please choose multiple dates. You can let us know your first choice in the special request section below. Saturday 12pm - 12:30pm *

Please let us know what days and times work best with your schedule for your Discover SCUBA Session: *

PADI Reactivate/Refresher SCUBA Program: Most classes sell out, so please choose multiple dates. You can let us know your first choice in the special request section below. Sunday 6:45am - 8:45am *

Please let us know what days and times work best with your schedule for your Reactivate/Refresher SCUBA Program:

Upgrade to High Perforance Rental Gear:

Hydros Pro BCD and MK25/A700 Regulator - $50

Student #1 First Name: *

Student #1 Last Name: *

Parents/Guardian First and Last Name (if student is under the age of 18):

Relationship to the Student:

Certification Agency (ie: PADI, Naui, SSI): *

Certification #: *

Please upload a picture of your certification card

Phone Number: *

Student #1 Email Address: *

Student #1 Birth Date: Month/Day/Year *

Student #1 Age: *

Street Address: *

City: *

Zip Code: *

Student #1 Height: *

Student #1 Weight: *

Student #1 Shoe Size: *

Add additional students? Same household only

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Student #2 First Name: *

Student #2 Last Name: *

Student #2 Email Address: *

Certification Agency (ie: PADI, Naui, SSI): *

Student #2 Certification #: *

Please upload a picture of your certification card *

Student #2 Height: *

Student #2 Weight: *

Student #2 Shoe Size: *

Student #2 Birth Date: Month/Day/Year *

Student #3 First Name: *

Student #3 Last Name: *

Student #3 Email Address: *

Certification Agency (ie: PADI, Naui, SSI): *

Student #3 Certification #: *

Please upload a picture of your certification card

Student #3 Height: *

Student #3 Weight: *

Student #3 Shoe Size: *

Student #3 Birth Date: Month/Day/Year *

You will be receiving a confirmation email within 24 hours. If you do not receive it, please check your spam folder and call 925.687.5354 between the hours of noon and 5pm - Tuesday through Sunday. It is your responsibility to contact us, if you do not receive your confirmation email.

***Medical Waiver: If a signed physician ( Click here to view the medical waiver PADI Medical Waiver ) is required for class attendance and the student fails to attain one before the class start date, Pacific Ocean Sports will do their best to help you reschedule attendance for the next available class date; however, rescheduling classes is subject to re-booking fees of $300 per student. If your physician deems you not fit to dive, you must notify Pacific Ocean Sports within 21 days prior to the start of class or you will be subject to the standard course cancellation policy.

Cancellation or Course Change Policy – Signing below means you have read and understand Pacific Ocean Sports Cancellation or Course Change Policy. *

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By signing below I have read the (Click here to view the medical waiver) PADI Medical Waiver and can confirm, if needed I will give Pacific Ocean Sports the 3rd page with my Dr. signature at least 7 days before my course start date. If not, I will be responsible for my course rescheduling fee of $200. No refunds will be given. *

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Payment Type: Credit Card For Secure Online Payment or Payment Over The Phone
Credit card billing address and 3 or 4 digit code on card must match the home address and driverse license of the reservation holder.
No P.O. Boxes accepted. No Discover accepted. *

Visa

MasterCard

American Express

Credit Card Over Phone - Spaces are limited. Spot will not be held until payment has been made

I will come in and pay at Pacific Ocean Sports - Spaces are limited. Spot will not be held until payment has been made

Credit Card Payment: Your Spot Will Not Be Held Until Your Payment Has Been Made. You must cancel at least 15 days before your first class date in order to receive a full refund. No Discover accepted

	Secure Form
Card Holders Name:	Secure Form
Credit Card Number:	Secure Form
Expiration Date (mm/yy):	Secure Form
3 Digit / 4 Digit CVV Code:	Secure Form
Billing Street Address:	Secure Form
Billing City:	Secure Form
Billing State:	Secure Form
Billing Zip Code:	Secure Form

Any Special Questions or Requests?