Mar J Un Sep

Day Cir cle app ropriat e m o nth.

Dive Center/Resort Location

PADI Dive Center/Resort No.

Emergency Contact Information


Photocopy may be used as student referral. Valid for 12 months from completion date.

Relationship __

□ PADI Discover Scuba Diving

I have personally conducted all three phases of the Discover Scuba Diving program (Water Skills Intro and Development and Initial Open Water Dive) as outlined in the PADI Instructor Manual for this participant.

Print Instructor Name First Middle I n iti a l Last

Instructor Signature Date



□ PADI Discover Scuba

This participant has completed all the skills and training from Confined Water Dive One of the PADI Open Water Diver course.

Print Instructor Name First Middle Initial Last


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