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e-Learning Access Codes & Certification Cards





Today's Date: April 19, 2024

Special note: When purchasing an e-Learning academic training code, once you have left SCUBA Network, the online code is NON-REFUNDABLE, nor EXCHANGEABLE. All e-Learning code sales are final and are good for one year from the date of purchase before expiration. If the e-Learning code expires, the code will no longer be accessible and a new code will need to be purchased.

 

VIDEO/PHOTOGRAPH RELEASE

I hereby grant SCUBA Network, the irrevocable right and permission to use photographs and/or video recordings of me on Company social media, websites and in publications, promotional flyers, educational materials, derivative works, or for any other similar purpose without compensation to me.

I understand and agree that such photographs and/or video recordings of me may be placed on the Internet. I also understand and agree that I may be identified by name and/or title in printed. Internet or broadcast information that might accompany the photographs and/or video recordings of me. I waive the right to approve the final product. I agree that all such portraits, pictures, photographs, video and audio recordings, and any reproductions thereof. and all plates, negatives, recording tape and digital files are and shall remain the property of SCUBA Network.

I hereby release, acquit and forever discharge SCUBA Network, its current and former trustees, agents, officers and employees of the above-named entities from any and all claims, demands, rights, promises, damages and liabilities arising out of or in connection with the use or distribution of said photographs and/or video recordings. including but not limited to any claims for invasion of privacy, appropriation of likeness or defamation.

I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name or, if I am less than eighteen years old, that my parent or guardian has signed this release form below. This release is binding on me and my heirs, assigns and personal representatives.

 



First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Salesperson at Sign-UP: *

E-Learning Code Purchased:

Student Registration Information for C-Card Processing



Store Location: *

Course: *

Student Name (first/last): *

D.O.B. *
Would you like a physical certification card? ($22.95 each)*
No
Yes

Number of physical certifications requested:

(If no, student can access "digital" certification card and save to electronic devices)


Would you like a photo on your certification card? ($5)*
No
Yes

(The replacement card fee after certification is processed is currently: $35.00)


First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Salesperson at Sign-UP: *

E-Learning Code Purchased:

Student Registration Information for C-Card Processing



Store Location: *

Course: *

Student Name (first/last): *

D.O.B. *
Would you like a physical certification card? ($22.95 each)*
No
Yes

Number of physical certifications requested:

(If no, student can access "digital" certification card and save to electronic devices)


Would you like a photo on your certification card? ($5)*
No
Yes

(The replacement card fee after certification is processed is currently: $35.00)


Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Salesperson at Sign-UP: *

E-Learning Code Purchased:

Student Registration Information for C-Card Processing



Store Location: *

Course: *

Student Name (first/last): *

D.O.B. *
Would you like a physical certification card? ($22.95 each)*
No
Yes

Number of physical certifications requested:

(If no, student can access "digital" certification card and save to electronic devices)


Would you like a photo on your certification card? ($5)*
No
Yes

(The replacement card fee after certification is processed is currently: $35.00)


Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Salesperson at Sign-UP: *

E-Learning Code Purchased:

Student Registration Information for C-Card Processing



Store Location: *

Course: *

Student Name (first/last): *

D.O.B. *
Would you like a physical certification card? ($22.95 each)*
No
Yes

Number of physical certifications requested:

(If no, student can access "digital" certification card and save to electronic devices)


Would you like a photo on your certification card? ($5)*
No
Yes

(The replacement card fee after certification is processed is currently: $35.00)


Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Salesperson at Sign-UP: *

E-Learning Code Purchased:

Student Registration Information for C-Card Processing



Store Location: *

Course: *

Student Name (first/last): *

D.O.B. *
Would you like a physical certification card? ($22.95 each)*
No
Yes

Number of physical certifications requested:

(If no, student can access "digital" certification card and save to electronic devices)


Would you like a photo on your certification card? ($5)*
No
Yes

(The replacement card fee after certification is processed is currently: $35.00)


Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Salesperson at Sign-UP: *

E-Learning Code Purchased:

Student Registration Information for C-Card Processing



Store Location: *

Course: *

Student Name (first/last): *

D.O.B. *
Would you like a physical certification card? ($22.95 each)*
No
Yes

Number of physical certifications requested:

(If no, student can access "digital" certification card and save to electronic devices)


Would you like a photo on your certification card? ($5)*
No
Yes

(The replacement card fee after certification is processed is currently: $35.00)


Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Salesperson at Sign-UP: *

E-Learning Code Purchased:

Student Registration Information for C-Card Processing



Store Location: *

Course: *

Student Name (first/last): *

D.O.B. *
Would you like a physical certification card? ($22.95 each)*
No
Yes

Number of physical certifications requested:

(If no, student can access "digital" certification card and save to electronic devices)


Would you like a photo on your certification card? ($5)*
No
Yes

(The replacement card fee after certification is processed is currently: $35.00)


Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Salesperson at Sign-UP: *

E-Learning Code Purchased:

Student Registration Information for C-Card Processing



Store Location: *

Course: *

Student Name (first/last): *

D.O.B. *
Would you like a physical certification card? ($22.95 each)*
No
Yes

Number of physical certifications requested:

(If no, student can access "digital" certification card and save to electronic devices)


Would you like a photo on your certification card? ($5)*
No
Yes

(The replacement card fee after certification is processed is currently: $35.00)


Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Salesperson at Sign-UP: *

E-Learning Code Purchased:

Student Registration Information for C-Card Processing



Store Location: *

Course: *

Student Name (first/last): *

D.O.B. *
Would you like a physical certification card? ($22.95 each)*
No
Yes

Number of physical certifications requested:

(If no, student can access "digital" certification card and save to electronic devices)


Would you like a photo on your certification card? ($5)*
No
Yes

(The replacement card fee after certification is processed is currently: $35.00)


Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Salesperson at Sign-UP: *

E-Learning Code Purchased:

Student Registration Information for C-Card Processing



Store Location: *

Course: *

Student Name (first/last): *

D.O.B. *
Would you like a physical certification card? ($22.95 each)*
No
Yes

Number of physical certifications requested:

(If no, student can access "digital" certification card and save to electronic devices)


Would you like a photo on your certification card? ($5)*
No
Yes

(The replacement card fee after certification is processed is currently: $35.00)


Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Salesperson at Sign-UP: *

E-Learning Code Purchased:

Student Registration Information for C-Card Processing



Store Location: *

Course: *

Student Name (first/last): *

D.O.B. *
Would you like a physical certification card? ($22.95 each)*
No
Yes

Number of physical certifications requested:

(If no, student can access "digital" certification card and save to electronic devices)


Would you like a photo on your certification card? ($5)*
No
Yes

(The replacement card fee after certification is processed is currently: $35.00)


Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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