Waiver - English
Health form for underwater activities
Please take 4 minutes to complete this questionnaire.
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First name *
Last name *
Born on *
MM
/
DD
/
YYYY
Nationality *
Adress in Bora Bora *
Phone number
Email *
Are you certified
SSI
PADI
NAUI
CMAS / FFESSM
Other
Yes
No
Clear selection
Certification level
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