SS Open Water Form – Simply Scuba

Book Now

Simply Scuba Registration Form
RM_Stats
Personal Particulars
Select Your Course / Activity
Activity Selection^*
Kindly select the type of Course / Activity

Your Information
First Name^*
Last Name
Gender^*
Male

Female

Date of Birth
Please kindly enter Date Of Birth
Nationality^*
Where are you from?
Passport No^*
Please kindly enter your passport number.
Upload Photo:
Please kind keep ur file sizes to less than 200KB; Leave empty if not needed
For Open Water Dive Courses, a picture of yourself would be required.
For Adv. Open Water / Rescue / Dive Master Dive Courses, if you are an existing customer, you may choose to not upload a photo.
For all new customers, a photo would be needed.

Contact Information
Email^*
Mobile Number
Please Enter Your Mobile Number

Your Address
Address 1^*
Kindly Enter Your Address
Address 2^*
Please Enter Your Unit Number
Country^*
Kindly enter the country of residence
Postal Code^*
Please enter only the postal code.

Insurance?
Do you need Travel Insurance?^*
Yes

No

Insurance against travel agent insolvency / travel insurance needed? If "yes", we will arrange for agent from AIG to contact you.

GROUP SIGN UP?
Do you have a group leader?^*
Yes

No

This only applies to participants with group sign-ups. Select a group leader amongst your group and fill in the field below with their FULL NAME
Group Leader Name^*
Please kindly enter Group Leader's Full Name

PADI Open Water Course
Padi Open Water Course
Complete this section only if you are signing up for PADI Open Water Course

Theory Lesson Date
Any Tuesday @1830 Hrs
Date for Theory Lesson (Only Tuesday)
Pick Any Tuesday after today.

Pool Session Date
Any Saturday @ 1030hrs Recreation Department. Orchid Country Club Olympic Pool
Date for Pool Session
Please pick any Saturday after today.

Dive Booking Date
Please take note that trip should be booked at least 3 Weeks in advance.
Date For Dive Trip Booking
Please take note that trip should be booked at least 3 Weeks in advance.
Terms
Terms & Conditions
Please kindly read the following terms and conditions and check the box before submitting the form.

Terms & Conditions

Payment made is neither refundable (in part or whole) nor transferable for any reasons whatsoever. Dive trip insurance is strongly advised so that claims can be made through that.

Change of dates for dive trip is permitted only with at least 2 weeks advance notice, subject to availability.

Postponement/ Additional charges for Dive Trip: Same week S$180, 2 days before full amount.

Trip dates are to be made at least TWO (2) weeks in advance, subject to availability.

Does not include dive insurance of S$30. Highly recommended!

Divers are to register on our website with full details uploaded.

Divers who have not dived for 9 months or more, a refresher course is required. (Any Sat 1030 am @ S$180).

Schedules mentioned above are subject to change without prior notice, depending on natural causes (tides, currents, weather, etc…)

Must be able to swim 200m and comfortable in the water.

Medical form to look through. A “yes” indicated requires a doctor’s letter.

Discharge of Liability
In consideration of “Simply Scuba Pte Ltd.” (shall include the employees, servants or agents thereof) accepting this offer (which includes this condition, booking conditions & the medical statements )to be included in this expedition/course, Simply Scuba Pte Ltd is hereby discharged by me/us and my/our executors, administrators and dependants from all liability or responsibility for damage arising out of or incidental to this dive expedition/course and whether or not such damage and/or injury is caused or contributed to be any negligence on the part of Simply Scuba Pte Ltd.

Medical Statement
I state that I am in good health for diving, I have no medical history of lung and heart disorders, asthma or epilepsy, neither am I an insulin dependant diabetic. If I am taking any medication whatsoever, I will obtain and follow medical advice before undertaking your expedition/course if I have had surgery within thirty(30) days of the expedition/course or if I have a chest cold or respiratory congestion on the expedition/course. I understand that if I have any medical condition contrary to these requirements, I must produce a diving medical certificate completed by a diving medical specialist. Should I require medical evacuation, I agree to pay any costs incurred on my behalf and you are authorised to make medical and transport arrangements as may be determined necessary or desirable in my interests.

Rental Agreement
I agree to reimburse Simply Scuba Pte Ltd for any of their diving equipment, lost or damaged whilst in my care.

Booking Conditions And Cancellation Policies (Courses)
Payment made is neither refundable (in part or whole) nor transferable for any reasons whatsoever. Dive trip insurance is strongly advised so that claims can be made through that. Please make sure medical is cleared before payment is done. Change of dates for pool practical or dive trip is permitted only with at least 2 weeks advance notice, subject to availability and additional charges. Postponement/ Additional charges for Dive Trip: Same week S$180, 2 days before full amount forfeited. Postponement/ Additional charges for Pool: S$80 per change. Additional Pool Practical session charges: S$80 per session Bookings and confirmation to be made at least Two (2) weeks in advance, subject to availability. Must be able to swim 200m and comfortable in the water. This will be tested. Students are to register on our website with full details uploaded. Email jpeg photo to chris@simplyscuba.com.sg Students are strongly recommended to do pool practical session at least Two (2) weeks before your scheduled dive trip departure dates. Schedules mentioned on our website are subjected to changes without prior notice, depending on natural causes (tides, currents, weather, etc…).

Booking Conditions And Cancellation Policies (Trips)
Payment made is neither refundable (in part or whole) nor transferable for any reasons whatsoever. Dive trip insurance is strongly advised so that claims can be made through that. Postponement/ Additional charges for Dive Trip: Same week S$180, 2 days before full amount forfeited. Bookings and confirmation to be made at least Two (2) weeks in advance, subject to availability. Must have dived in the last 9 months, if not a refresher course is compulsory. Divers are to register on our web site with full details uploaded. Certification card and log book to be brought along for dive trip. Schedules mentioned in our web site are subjected to changes without prior notice, depending on natural causes (tides, currents, weather, etc…)

Terms & Conditions.
I have read and understood the Terms & Conditions stated above.
<<<Promotion Terms & Conditions>>> Payment made is neither refundable (in part or whole) nor transferable for any reasons whatsoever. Dive trip insurance is strongly advised so that claims can be made through that. Change of dates for dive trip is permitted only with at least 2 weeks advance notice, subject to availability. Postponement/ Additional charges for trip: Same week S$180, 2 days before full amount. Trip dates are to be made at least TWO (2) weeks in advance, subject to availability. Does not include dive insurance of S$30. Highly recommended! Divers are to register on our website with full details uploaded. Divers who have not dived for 9 months or more, a refresher course is required. (Any Sat 1030 am @ S$180). Schedules mentioned above are subject to change without prior notice, depending on natural causes (tides, currents, weather, etc…) Must be able to swim 200m and comfortable in the water. Medical form to look through. A “yes” indicated requires a doctor’s letter. <<<DISCHARGE OF LIABILITY>>> In consideration of “Simply Scuba Pte Ltd.” (shall include the employees, servants or agents thereof) accepting this offer (which includes this condition, booking conditions & the medical statements )to be included in this expedition/course, Simply Scuba Pte Ltd is hereby discharged by me/us and my/our executors, administrators and dependants from all liability or responsibility for damage arising out of or incidental to this dive expedition/course and whether or not such damage and/or injury is caused or contributed to be any negligence on the part of Simply Scuba Pte Ltd. <<<MEDICAL STATEMENT>>> I state that I am in good health for diving, I have no medical history of lung and heart disorders, asthma or epilepsy, neither am I an insulin dependent diabetic. If I am taking any medication whatsoever, I will obtain and follow medical advice before undertaking your expedition/course if I have had surgery within thirty(30) days of the expedition/course or if I have a chest cold or respiratory congestion on the expedition/course. I understand that if I have any medical condition contrary to these requirements, I must produce a diving medical certificate completed by a diving medical specialist. Should I require medical evacuation, I agree to pay any costs incurred on my behalf and you are authorised to make medical and transport arrangements as may be determined necessary or desirable in my interests. <<<RENTAL AGREEMENT>>> I agree to reimburse Simply Scuba Pte Ltd for any of their diving equipment, lost or damaged whilst in my care. <<<BOOKING CONDITIONS & CANCELLATION POLICIES (COURSES)>>> Payment made is neither refundable (in part or whole) nor transferable for any reason whatsoever. Please make sure medical is cleared before payment is done. Change of dates for pool practical or dive trip is permitted only with at least 2 weeks advance notice, subject to availability and additional charges. Postponement/ Additional charges for Dive Trip: Same week S$180, 2 days before full amount forfeited. Postponement/ Additional charges for Pool: S$80 per change. Additional Pool Practical session charges: S$80 per session Bookings and confirmation to be made at least Three (3) weeks in advance, subject to availability. Must be able to swim 200m and comfortable in the water. This will be tested. Students are to register on our website with full details uploaded. Email jpeg photo to chris@simplyscuba.com.sg Students are strongly recommended to do pool practical session at least Two (2) weeks before your scheduled dive trip departure dates. Schedules mentioned on our website are subjected to changes without prior notice, depending on natural causes (tides, currents, weather, etc…) <<<BOOKING CONDITIONS & CANCELLATION POLICIES (TRIPS)>>> Payment made is neither refundable (in part or whole) nor transferable for any reasons whatsoever. Dive trip insurance is strongly advised so that claims can be made through that. Postponement/ Additional charges for Dive Trip: Same week S$180, 2 days before full amount forfeited. Bookings and confirmation to be made at least Two (2) weeks in advance, subject to availability. Must have dived in the last 9 months, if not a refresher course is compulsory. Divers are to register on our website with full details uploaded. Certification card and log book to be brought along for dive trip. Schedules mentioned on our website are subjected to changes without prior notice, depending on natural causes (tides, currents, weather, etc…)
Please check the box if you are agreeable to our Terms & Conditions.
Terms
Terms & Conditions
Please kindly read the following terms and conditions and check the box before submitting the form.

Terms & Conditions

Payment made is neither refundable (in part or whole) nor transferable for any reasons whatsoever. Dive trip insurance is strongly advised so that claims can be made through that.

Change of dates for dive trip is permitted only with at least 2 weeks advance notice, subject to availability.

Postponement/ Additional charges for Dive Trip: Same week S$180, 2 days before full amount.

Trip dates are to be made at least TWO (2) weeks in advance, subject to availability.

Does not include dive insurance of S$30. Highly recommended!

Divers are to register on our website with full details uploaded.

Divers who have not dived for 9 months or more, a refresher course is required. (Any Sat 1030 am @ S$180).

Schedules mentioned above are subject to change without prior notice, depending on natural causes (tides, currents, weather, etc…)

Must be able to swim 200m and comfortable in the water.

Medical form to look through. A “yes” indicated requires a doctor’s letter.

Discharge of Liability
In consideration of “Simply Scuba Pte Ltd.” (shall include the employees, servants or agents thereof) accepting this offer (which includes this condition, booking conditions & the medical statements )to be included in this expedition/course, Simply Scuba Pte Ltd is hereby discharged by me/us and my/our executors, administrators and dependants from all liability or responsibility for damage arising out of or incidental to this dive expedition/course and whether or not such damage and/or injury is caused or contributed to be any negligence on the part of Simply Scuba Pte Ltd.

Medical Statement
I state that I am in good health for diving, I have no medical history of lung and heart disorders, asthma or epilepsy, neither am I an insulin dependant diabetic. If I am taking any medication whatsoever, I will obtain and follow medical advice before undertaking your expedition/course if I have had surgery within thirty(30) days of the expedition/course or if I have a chest cold or respiratory congestion on the expedition/course. I understand that if I have any medical condition contrary to these requirements, I must produce a diving medical certificate completed by a diving medical specialist. Should I require medical evacuation, I agree to pay any costs incurred on my behalf and you are authorised to make medical and transport arrangements as may be determined necessary or desirable in my interests.

Rental Agreement
I agree to reimburse Simply Scuba Pte Ltd for any of their diving equipment, lost or damaged whilst in my care.

Booking Conditions And Cancellation Policies (Courses)
Payment made is neither refundable (in part or whole) nor transferable for any reasons whatsoever. Dive trip insurance is strongly advised so that claims can be made through that. Please make sure medical is cleared before payment is done. Change of dates for pool practical or dive trip is permitted only with at least 2 weeks advance notice, subject to availability and additional charges. Postponement/ Additional charges for Dive Trip: Same week S$180, 2 days before full amount forfeited. Postponement/ Additional charges for Pool: S$80 per change. Additional Pool Practical session charges: S$80 per session Bookings and confirmation to be made at least Two (2) weeks in advance, subject to availability. Must be able to swim 200m and comfortable in the water. This will be tested. Students are to register on our website with full details uploaded. Email jpeg photo to chris@simplyscuba.com.sg Students are strongly recommended to do pool practical session at least Two (2) weeks before your scheduled dive trip departure dates. Schedules mentioned on our website are subjected to changes without prior notice, depending on natural causes (tides, currents, weather, etc…).

Booking Conditions And Cancellation Policies (Trips)
Payment made is neither refundable (in part or whole) nor transferable for any reasons whatsoever. Dive trip insurance is strongly advised so that claims can be made through that. Postponement/ Additional charges for Dive Trip: Same week S$180, 2 days before full amount forfeited. Bookings and confirmation to be made at least Two (2) weeks in advance, subject to availability. Must have dived in the last 9 months, if not a refresher course is compulsory. Divers are to register on our web site with full details uploaded. Certification card and log book to be brought along for dive trip. Schedules mentioned in our web site are subjected to changes without prior notice, depending on natural causes (tides, currents, weather, etc…)

Terms & Conditions.
<<<Promotion Terms & Conditions>>> Payment made is neither refundable (in part or whole) nor transferable for any reasons whatsoever. Dive trip insurance is strongly advised so that claims can be made through that. Change of dates for dive trip is permitted only with at least 2 weeks advance notice, subject to availability. Postponement/ Additional charges for trip: Same week S$180, 2 days before full amount. Trip dates are to be made at least TWO (2) weeks in advance, subject to availability. Does not include dive insurance of S$30. Highly recommended! Divers are to register on our website with full details uploaded. Divers who have not dived for 9 months or more, a refresher course is required. (Any Sat 1030 am @ S$180). Schedules mentioned above are subject to change without prior notice, depending on natural causes (tides, currents, weather, etc…) Must be able to swim 200m and comfortable in the water. Medical form to look through. A “yes” indicated requires a doctor’s letter. <<<DISCHARGE OF LIABILITY>>> In consideration of “Simply Scuba Pte Ltd.” (shall include the employees, servants or agents thereof) accepting this offer (which includes this condition, booking conditions & the medical statements )to be included in this expedition/course, Simply Scuba Pte Ltd is hereby discharged by me/us and my/our executors, administrators and dependants from all liability or responsibility for damage arising out of or incidental to this dive expedition/course and whether or not such damage and/or injury is caused or contributed to be any negligence on the part of Simply Scuba Pte Ltd. <<<MEDICAL STATEMENT>>> I state that I am in good health for diving, I have no medical history of lung and heart disorders, asthma or epilepsy, neither am I an insulin dependent diabetic. If I am taking any medication whatsoever, I will obtain and follow medical advice before undertaking your expedition/course if I have had surgery within thirty(30) days of the expedition/course or if I have a chest cold or respiratory congestion on the expedition/course. I understand that if I have any medical condition contrary to these requirements, I must produce a diving medical certificate completed by a diving medical specialist. Should I require medical evacuation, I agree to pay any costs incurred on my behalf and you are authorised to make medical and transport arrangements as may be determined necessary or desirable in my interests. <<<RENTAL AGREEMENT>>> I agree to reimburse Simply Scuba Pte Ltd for any of their diving equipment, lost or damaged whilst in my care. <<<BOOKING CONDITIONS & CANCELLATION POLICIES (COURSES)>>> Payment made is neither refundable (in part or whole) nor transferable for any reason whatsoever. Please make sure medical is cleared before payment is done. Change of dates for pool practical or dive trip is permitted only with at least 2 weeks advance notice, subject to availability and additional charges. Postponement/ Additional charges for Dive Trip: Same week S$180, 2 days before full amount forfeited. Postponement/ Additional charges for Pool: S$80 per change. Additional Pool Practical session charges: S$80 per session Bookings and confirmation to be made at least Three (3) weeks in advance, subject to availability. Must be able to swim 200m and comfortable in the water. This will be tested. Students are to register on our website with full details uploaded. Email jpeg photo to chris@simplyscuba.com.sg Students are strongly recommended to do pool practical session at least Two (2) weeks before your scheduled dive trip departure dates. Schedules mentioned on our website are subjected to changes without prior notice, depending on natural causes (tides, currents, weather, etc…) <<<BOOKING CONDITIONS & CANCELLATION POLICIES (TRIPS)>>> Payment made is neither refundable (in part or whole) nor transferable for any reasons whatsoever. Dive trip insurance is strongly advised so that claims can be made through that. Postponement/ Additional charges for Dive Trip: Same week S$180, 2 days before full amount forfeited. Bookings and confirmation to be made at least Two (2) weeks in advance, subject to availability. Must have dived in the last 9 months, if not a refresher course is compulsory. Divers are to register on our website with full details uploaded. Certification card and log book to be brought along for dive trip. Schedules mentioned on our website are subjected to changes without prior notice, depending on natural causes (tides, currents, weather, etc…)
Please check the box if you are agreeable to our Terms & Conditions.

Book Now

Simply Scuba Registration Form

Select Your Course / Activity

Your Information

Contact Information

Your Address

Insurance?

GROUP SIGN UP?

Padi Open Water Course

Theory Lesson Date

Pool Session Date

Dive Booking Date

Terms & Conditions

Terms & Conditions

Discharge of Liability

Medical Statement

Rental Agreement

Booking Conditions And Cancellation Policies (Courses)

Booking Conditions And Cancellation Policies (Trips)

Terms & Conditions

Terms & Conditions

Discharge of Liability

Medical Statement

Rental Agreement

Booking Conditions And Cancellation Policies (Courses)

Booking Conditions And Cancellation Policies (Trips)

Tioman Departure Point

About Simply Scuba

Protect Yourself

What’s New

Register Now

Where We Are