Medical Questionnaire

RequiredPlease check definitely.

You must read “Medical Statement Participant Record (Confidential Information)”before making a reservation.
If you have positive responses, you must seek the advice of your physician prior to engaging in dive activities.

There is no positive responses.
There is some positive responses, and consult with a physician prior to participating in scuba diving.

※All participants need to read “Medical Statement Participant Record (Confidential Information)”before making a reservation.

Applicant’s information

RequiredApplicant’ｓ Name

RequiredNationality

RequiredSex

Man Woman

RequiredAge

years old

RequiredEmail

RequiredEmail (Check again)

Questions about schedule

RequiredNumber of participants

–12345678910 pax

RequiredArrival and departure

Arrival   Choice the date　

Departure   Choice the date

RequiredPlanned dates of diving

  From  Choice the date   To  Choice the date   Total：days

It is impossible to travel by air on the same day as you have gone diving. You have to take a rest 12 hours before your flight.

RequiredAccommodation

RequiredVisit method

Rent a Car
Need transportation　
You must be staying in the city area.

Equipment rental

RequiredEquipment rental

We request customors to dive with divecomputer. If you don’t have, rental please.

No rental needed
Rental all gears needed

Equipment rental
Sizes

Height  cm 
Weight  kg 
Shoe size  cm 

Tell us your own gears. (Type here.)

Dive logs

RequiredPlease tell your dive logs

Number of dives logged： dives    
The latest date of dives： year   month 

 Refresh diving skills at 1st dive.
※1dive fee + 2160yen (tax in) needed.
※We recomend refresh dive. The latest date of dives of yours is over 6 monthes before or you feel something anxious about diving.

Participant Information

Questions & requests

Comfirmation items

ImpotantCancellation charge

Cancellation charge is required when you cancell the reservation because of your condition.

7days before ~ 12:00 of the day before
12:00 of the day before ~ That day

50%
100%

※If you cancell the reservation because of the typhoon, we don’t reqest the charge.

Required

I acknowledge the above confirmation items.
You can’t send without the check.