Waiver - English
Health form for underwater activities
Please take a few minutes to complete this questionnaire
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DIVER'S INFORMATION
First name *
Last name *
Date of birth *
MM
/
DD
/
YYYY
Nationality *
Where are you lodging in Bora Bora? *
Date of excursion *
MM
/
DD
/
YYYY
Phone number
Email address  *
PHOTOGRAPHS AND VIDEO
I grant BORA OCEAN ADVENTURES and its representatives irrevocable permission to publish any photographs or videos you have taken of me in Bora Bora during my stay. These images can be exploited in any form whatsoever. I declare that I am of legal age and that I am competent to sign this form in my own name. I have read and understood all implications of this waiver.
 *
Required
Are you certified?
SSI
PADI
NAUI
CMAS / FFESSM
Other
Yes
No
Clear selection
Certification level
When was your last dive? (If applicable)
MM
/
DD
/
YYYY
How many dives have you done approximately? (If applicable)
Clear selection
Next
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