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Dive Pirates
Training Adaptive Divers
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    • Adaptive Diver Application
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Search:
  • About Us
    • Inspiring Stories
    • Our Mission and Team
    • Partners and Sponsors
    • COVID-19 Update
  • Donate
    • Become a Member
    • Support a Diver’s Journey
    • Donate Now
    • Support Your Local Dive Chapter
    • Where the Money Goes
    • Maximize Your Impact
  • Become an Adaptive Diver
    • Medical Statement & Physician’s Release
    • Adaptive Diver Application
    • Become an Adaptive Dive Buddy
    • Adaptive Scuba Diving Resources
  • Get Involved
    • Attend Events
    • Key Largo Trip June 2022
    • Trip Sponsorship
    • Become a Dive Pirates Chapter
    • Become an Adaptive Instructor
    • Volunteer
    • Become a Volunteer Dive Buddy
    • Shop and Support Us
  • Captain’s Blog
  • Store
  • Contact Us

Adaptive Diver Application

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  2. Become an Adaptive Diver
  3. Adaptive Diver Application

Adaptive Diver Application

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    • All fields denoted with an * are mandatory.
    • You are able to save, and then return to this form to continue with the application process. If you select this option, you will receive the link in an email.
    • Please note do not upload your photo until you are ready to submit your application as it will not be saved.
  • Personal

  • Please provide the best form of communication for you (email, phone, text, facebook). Our volunteers will be organizing your training and travel and will need to be able to contact you regularly. Please respect their time and return calls or emails promptly.
  • Passport details

  • MM slash DD slash YYYY
  • Since our program includes an international dive trip, see video below, in order for us to continue processing your application or arrange any scuba training for you, you will need to obtain a valid passport. This will be your responsibility to complete. Once you have your passport we would love to hear back from you. Please select save and continue, and follow the link provided to continue applying once you have your passport in place.
    • Passport Application Process
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  • Emergency Contact Details

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  • Background

  • Please check all that apply.
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Please leave blank if still employed.
    MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Please leave blank if still employed.
    MM slash DD slash YYYY
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  • Fundraising

  • There is a lot of time, energy, and money invested by our volunteers, donors, and board of directors to make sure you have every opportunity to safely learn to be an adaptive diver and have a wonderful first experience in the open ocean. We need your commitment to attend all fundraising functions held by your chapter and share​ your fundraising page via your social networks at a minimum. Please check out some of our diver's stories!
    • INSPIRING STORIES
  • That's great, we are here to work with you and your buddy to make this happen. Help us help you make this a reality.
  • I'm sorry you feel that way. Maybe Dive Pirates isn't for you. We work together as a crew to support each other. If you don't want to reconsider then we wish you well on your journey.
    • HOME PAGE
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  • Medical

  • This information is very beneficial to your dive instructors.
  • For your safety, we do not accept applications from candidates who have a subcutaneous pump for pain management or for managing muscle spasms, or implanted devices due to the risk of rupture during the dive. If you have a question about your situation and would like to discuss in further detail we would welcome your call. Please call us on 1-877-393-3483.
    • HOME PAGE
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  • Sizing for equipment

    To enable us to provide the appropriate equipment please provide the following information.
  • ft/ in
  • lbs
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  • Media and Privacy Release

    • As part of our program, we will be taking photos and video of events in which you may be participating. We also store your information on a secure internet cloud in order for our team to access it for training and planning needs. For these reasons, we ask that YOU read the following statements IN FULL before checking the box.
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  • Statement of Understanding

    • The purpose of this Statement of Understanding is to provide you with the important responsibilities you have with becoming a recipient of the Dive Pirates Foundation. There is a lot of time, energy, and money invested by our volunteers, donors, board of directors, chapters, and instructors to make sure you have a wonderful time on your Dive Pirates Adventure. It's very important that these resources are not wasted. Dive Pirates will be providing any necessary scuba equipment and training for you and your dive buddy.
    • Please read and check the box for each item.
  • I will communicate as quickly as possible with my instructor, my chapter, and the Foundation. The best form of communication for me is (please check all that apply):
  • I understand there are some out-of-pocket expenses, please acknowledge each expense by checking the boxes
  • Agreement and Next Steps

    • At least one passport-style head and shoulder shot for use in fundraising activities.
    • Maximum File Size: 2MB
    • File type: .jpg, .jpeg
    Drop files here or
    Accepted file types: jpg, jpeg, Max. file size: 2 MB.
    • Please check all that apply
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