Dive Mentor | Program Enrollment Form

Participant Information

Name*

First Last

Do you have a nickname?

Date of Birth*

mm/dd/yyyy

Social Security Number*

Mobile Phone*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Participant's Status:*

High School Student / College Dependent
Adult / Independant

Marital Status:*

Please note that our dorm-style housing is only available for the candidate. If you have a partner and wish to stay together during your program, you will need to arrange your own housing separately at your own expense.

Single
Married
Civil Partnership
Divorced
Widowed

Choose Your Program

Have you participated in a Dive Mentor program before?*

Yes
No

What program did you attend before?

Welcome Back! We love it when our alumni return to attend programs again. Which program did you do with us before, and when?

Choose the Program Group you wish to enroll in today:*

Adventure Programs

For High School Students

Adventure Programs

For College Students

Recreational Scuba Training & Fun Diving

For non-professional (non vocational) training such as Open Water, Advanced, Rescue, Specialties, and fun dives or excursions

Vocational Training Programs

For adults 18 years or older (professional training)

If other, please explain here:

Preferred Location?*

Preferred number of weeks?

Are you already scuba certified?*

Yes
No

Social Media

Do you use social media?

Yes
No

Facebook Account

facebook.com/username

Instagram Account

@username

Twitter Account

@username

SnapChat Account

@username

Please upload a passport-type photograph:

Parent Contact Information

Please complete this section if the student is under the age of 18 years old or is currently a dependent.

First Name

Last Name

Relationship to Student

Does the student live at the same address as Parent/ Guardian?*

Yes
No

Parent's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Best Email

Mobile Phone

Alternative Phone

Emergency Contact

Emergency Contact*

First Last

Relationship to Student*

Other Family Member / Friend

Emergency Phone*

Emergency Email*

Expectations, Concerns, & Previous Experience

Tell us more:*

Would you like to answer some questions about your background and expectations? This will allows us to be more informed about how we can ensure you have the best possible experience with us. REQUIRED for all Professional or Vocational Applicants.

Yes
No

Why are you interested in this Program?

What kind of impact do you think it will have on you?

What are your biggest worries or concerns?

Where have you travelled out side of your home country?

What hobbies, interests or personal qualities do you have that you feel will be beneficial to your experience on this Program?

Please describe your experience in the water that is not SCUBA diving related:

Please include any questions or concerns you would like to discuss with a member of staff here:

Scuba Diving Experience

How many years have you been diving?

Location of original scuba certification?

Please list your certifications and the certification agencies (NAUI, PADI, SSI, etc.):

Please upload a scan or photograph of your most recent certification card (front and back):

How many dives have you completed?

Do you have your dives recorded in a log book?

Yes
No

Are you more experienced / comfortable in warm or cold water? Please explain:

Are you a DAN member?

Yes
No
I'd like to become a member

Dan Number:

Please enter your membership number here.

Have you ever had any medical emergencies related to SCUBA diving? Please explain:

Do you ever experience any discomfort when diving? Please explain:

Other Speciality Training Interests:

Your program comes with a number of certifications included in the tuition. As you are already certified, are there any other courses that interest you? (Choose as many as you like)

Program Deposit

A non-refundable deposit is required to enroll in all of Dive Mentor programs. We cannot hold or guarantee space until the deposit is received. Each program has its own deposit amount, so please be sure to choose the correct program. You will not be charged the deposit unless you are accepted into a program.

Deposit Amount:*

Please chose your program deposit amount. Recreational is for Open Water, Advanced, Specialities, etc. Vocation is for Dive Guide, Divemaster, Instructor, etc), Adventure is for Caribbean Residency, Study Abroad, etc.

Deposit Payment Method*

PayPal Address:

Please provide your PayPal address here. An invoice will be generated and sent to you directly.

Name on Credit Card

Credit Card Number

Expiration

CVC

Type of Account

Name on Bank Account

Account Number

Routing Number or Swift Code

Help Us Improve Our Reach

Please tell us how you heard about Dive Mentor's programs:

Application Processing

Statements of Understanding*

I understand that if my application is incomplete, I will be denied a place into Dive Mentor's Divemaster Internship Program.
I understand that it will take up to several weeks to process my application.
I understand that space is limited, and I am not guaranteed a spot.
I understand that Dive Mentor requires the execution of a Non Disclosure Agreement (NDA) to process my application, and that this document protects sensitive information and the privacy of both parties. I understand that I will not be offered a spot unless this document is downloaded, printed, signed, and returned to Dive Mentor. This document may be downloaded immediately after this Enrollment Form is submitted.
I understand that I should check my spam/promotions boxes in my email to ensure I do not miss any correspondance and I should consider "white listing" admissions@www.divementor.org to make sure I get emails regarding this application.

Terms of Service

Certification*

I hereby certify that all of the details I have provided are true and correct to the best of my knowledge. I understand that if any of my statements provided herein are later to be found false, that I may be removed from the program without being refunded my deposit or fees. I further certify that I have read and agree to the Terms of Service.

CAPTCHA

DIVE MENTOR PROGRAM ENROLLMENT FORM

Participant Information

Choose Your Program

Social Media

Parent Contact Information

Emergency Contact

Expectations, Concerns, & Previous Experience

Scuba Diving Experience

Program Deposit

Help Us Improve Our Reach

Application Processing

Terms of Service