We’re thrilled you’ve chosen the ZooKeeper Team for your scuba certification adventure! Participant Information Form Today's Date: First Name: Last Name: Email: Phone Number: Address: City: State: Zip: Date of Birth: Gender: Male Female Certifiying Agency: PADI SSI NAUI SDI Other N/A Other Agency: Highest Certification: Pending Open Water Open Water Advanced Open Water Deep (130") Wreck Night Diver Adaptive Support Diver Self-Reliant Diver Dive Master Assistant Instructor Instructor Master Scuba Diver Trainer IDC Staff Instructor Course Director Certification Number (0 if none): Nitrox Certified? Yes No Date of Last Dive: Total Number of Dives: Do you have current dive insurance? Yes No Dive Insurance Policy Number: I have the REQUIRED equpiment: Mask, Snorkel & Fins BCD (Buoyancy Compensator Device) Regulator Dive Computer Surface Marker Buoy (SMB) Scuba Tanks ZooKeeper Sling Spear with Tip Wetsuit Do you need to rent equipment? Yes No What equipment do you need to rent? BCD (Buoyancy Compensator Device) Regulator Dive Computer Scuba Tanks ZooKeeper Sling Spear with Tip Wetsuit Optional Recommended Equiptment: Dive Light Pointed Tip Dive Knife Shears for spine removal Dive Gloves Compass Do you need to upload a "passport" photo for your certification card? Yes No Certification Card Photo: Upload your completed required forms How did you find out about the course with the ZooKeeper Team? Friend, family member, or dive buddy recommendation Local dive shop or instructor Instagram, Facebook, YouTube or TikTok Google search Dive show, expo, or event Travel/vacation booking site or resort Advertisement or flyer Would you like to add anything? Submit
