Diver information
The following information is necessary to send electronic releases via PADI and process your certification. Note: If you are registering multiple family members, each person needs to have a separate personal email address. 
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Email *
Primary reason for completing this form: *
First Name   Middle Initial   Last Name *
Birth Day *
Birth Month *
Birth Year *
Gender Identification (required for certification processing) *
Best Contact Phone (Cell preferred) *
OK to text to contact phone number? *
Address *
City *
State *
Zip Code *
Approximate Weight (needed for BCD/wetsuit fit) *
Height (for BCD Fit) *
Shoe Size (using male sizing scale) *
Emergency Contact Name (if minor, should be parent's name) *
Emergency Contact Number (if minor, should be parent's phone) *
If minor, parent's email for electronic forms completion (must be a different from youth's email above)
If you are a BSA Scout also completing your Scuba Merit Badge, enter your unit number
Current Diving Certifications (include all training agencies) and Future Interests
Current Diving Certifications
Future Interest
None - new diver
Open Water Diver
Advanced Open Water Diver
Rescue Diver
Master Diver
Enriched Air Nitrox Diver
Peak Performance Buoyancy Diver
Digital Underwater Photography
Texas Lone Star State Diver
Deep Diver
Night Diver
Wreck Diver
Search and Recover Diver
Underwater Navigator Diver
Underwater Naturalist Diver
AWARE Fish Identification Diver
Boat Diver
Emergency First Response Primary and Secondary Care
Emergency Oxygen Provider
Divemaster
Drysuit Diver
Sidemount Diver
Solo Diver
Shark Conservation Diver
Dive Against Debris Diver
Clear selection
Gear - Current and Future Interests
Currently Own
Future Interest
Mask
Snorkel
Boots
Fins
BCD
Regulator
Computer
Pressure Gauge
Compass
Wetsuit
Tank
Weights
Reels
Other
Clear selection
Travel Interest?
Submit
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