Passenger information form

Passenger information form
Name*
Preferred nickname
If any, or if different from above
Date of departure*
Your trip's destination*
Legal name*
as it appears on passport
Legal Name (as it appears on your passport)*

First NameLast Name
Date of Birth*

MonthDayYear
Personal information
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
E-mail*
Phone Number

Area CodePhone Number
Number you can be reached on day of charter*

Area codePhone number
Identification information

Passport is required for all Bahamas and BVI trips and Passenger identification is required for all domestic passenger vessel voyages. Below please be prepared to enter some form of government issued identification. PLEASE NOTE: Passport cards are no longer accepted by the Bahamas!
Passport number*
Passport numbers only! Passport cards are no longer accepted by the Bahamas
Identification Type*
Please list type and state/country issued by
Identification number*
Passport expiration date*

MonthDayYear
Date
Country Issued by:*
Travel information
I will be arriving by
Arrival date and time
Airline and flight number
Arrival airport
Emergency contact information
In case of Emergency (ICE) Contact Name
Someone NOT traveling with you
ICE Phone Number*

Area CodePhone Number
Relationship
Dietary / Medical
Pertinent medications or medical conditions

0/150
Allergies and dietary restrictions: Please only list food allergies and medical restrictions below. Meals are prepared in a tiny galley and served family style. We cannot accommodate everyone's likes, dislikes, and personalized diets. Thank you for being flexible. We will always have lots of delicious options for you to eat each meal!

VegetarianPescatarian (no meat except fish)VeganOther allergy or restriction
Other medical dietary restrictions or food allergies

0/150
Diving Experience
I am a:*

DiverNon-diver
Cert. level
We are "Rebreather Friendly."

We have a booster on board, AL80cf bail out tanks, and can provide additional O2 for rebreathers. You provide everything else. Please notify the office so we can arrange O2 for your trip. If you do not get the OK from the office, or you do not give us enough notice, you will not be able to dive your rebreather.
Please Note: Beginning in 2023 Nitrox certification is Required for all divers! If you are not already nitrox certified, please contact your local dive shop or the office at Juliet and we can help arrange for certification prior to your trip.
Are you certified to dive with enriched air ?

I'm already nitrox certifiedI'd like to get nitrox certified on boardI will get nitrox certified before the trip
Certification Agency*
Certification number
Date of last dive

MonthDayYear
Number of dives
Optional: Upload a picture of your Nitrox certification card to save time during check-in, or your open water card if you are getting nitrox certified on board.

Or you can email it later if you'd prefer
Cancelof
DAN/Diving insurance policy and #*
I will need to rent

BCDRegulatorDive computer
BCD size (unisex size)
If you would like to pre-pay for rental gear or diving course deposits you can do so on the payment page or contact us directly.
Travel Insurance
As stated in your confirmation documents, Juliet Sailing and Diving does not offer refunds or credits for charters cancelled or shortened due to adverse weather, acts of God, or events not within the reasonable control of Juliet Sailing and Diving. We strongly suggest that you obtain travel insurance for your vacation, especially during hurricane season.

We highly recommend the purchase of combination dive and travel insurance as dive travel can be unique and some dive-specific cancellations or interruptions may not be covered by traditional Travel Insurance Policies. Check details with your provider or see below for some agencies we recommend:

DAN - http://www.diversalertnetwork.org/trip

Dive Assure - http://www.diveassure.com/new
I understand the statements above and:*

I have purchased travel insuranceI plan to purchase insuranceI do not plan to purchase insurance
Additional information
How many times have you been on board Juliet?
Roommate preference
Roommate (if known)
Roommate accommodation options:

We prefer one bedWe prefer two beds
Additional comments or requests?

0/150
Signature

Clear
Should be Empty:

Passenger information form

Personal information

Identification information

Travel information

Emergency contact information

Dietary / Medical

Diving Experience

Travel Insurance

Additional information