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✦ SSI Certified Centre 🤿 Expert Instructors 🛡 Safety First

1 Personal Details

Phone / WhatsApp *

First Name *

Middle (opt.)

Last Name *

Email Address *

Gender

Preferred Name (opt.)

Nationality

Date of Birth

Home Address

2 Emergency Contact

Contact Name

Relationship

Emergency Phone

3 Package Details

I'm already staying at the resort (in-house guest)

Settled directly with the resort — no payment needed at the dive centre.

What are you looking for?

Select Package

Check-in Date *

Check-out Date *

4 Equipment

Need Rental Equipment?

BCD Size

Fin / Shoe Size

Nitrox

Request Nitrox

Enhanced air mixture for extended bottom time

Interested in a Nitrox Course?

5 Dive Skills

Diving Since

No. of Dives

Agency

Level

Cert. Number (optional)

Dive Insurance Number (optional)

Nitrox Cert. Agency (opt.)

Nitrox Cert. Number (opt.)

Preferred Diving Style

Preferred Snorkeling Style

6 Medical Declaration

Safety Note: If you have asthma, heart disease, or are pregnant, consult a doctor before diving. Honesty saves lives.

Any medical conditions?

Asthma Heart Disease High Blood Pressure Epilepsy / Seizures

Additional Notes (optional)

7 Dietary & Allergies

Dietary Preference (optional)

Allergies (optional)

I certify that I am physically fit to participate in diving activities. I agree to hold harmless the Operator from any claims arising from my participation.

I agree to the privacy policy and data handling practices of the Operator.

Booking Summary

Course / Package —

Package Price RM 0 / pax

Estimated Total RM 0

Our crew will confirm and arrange the deposit via WhatsApp.

· ·

Registration Sent!

Reference
Our crew will contact you shortly to confirm availability and arrange the deposit.

Package

Date

Estimated Total

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