Passenger information form

Passenger information form
Name *
Date of Departure *

Month Day Year
Date Date Picker Icon
Preferred nickname
If any, or if different from above
Group name / Leader
If applicable
Personal information

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *
Phone Number

Area Code Phone Number
Number you can be reached on day of charter *
Customs information
Legal name *
as it appears on passport
Date of Birth *

Month Day Year
Passport number *
REQUIRED for all Bahamas and BVI trips. For all other trips (Florida Keys, St. Croix), please enter 0000
Country issued by *
Travel information
Arrival date and time
I will be arriving by
I need a parking pass ($70/week)
Airline and flight number
Arrival airport
Emergency contact information
Name
Someone NOT traveling with you
Phone Number *

Area Code Phone Number
Relationship
Dietary / Medical
Known Allergies
Pertinent medications or medical conditions
Dietary restrictions. preferences, requests
Diving Experience
I am a:

Diver Non-diver
Cert. level
Number of dives
Date of last dive

Month Day Year
Dive insurance policy and #
Will you be diving nitrox?

No Yes I'd like to get nitrox certified on board
I will need to rent

BCD Regulator Dive computer
BCD size (unisex size)
If you would like to pre-pay for Nitrox, parking pass, 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 insurance I plan to purchase insurance I 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 bed We prefer two beds
Additional comments or requests?
Newsletter Opt-In

Please subscribe me to Juliet's monthly newsletter.
Signature

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Passenger information form

Personal information

Customs information

Travel information

Emergency contact information

Dietary / Medical

Diving Experience

Travel Insurance

Additional information