Diver Name: Jana Matouskova Birthdate: ____/____/____

Mailing Address: ____________________________________________________________

City: _________________________________ State/Province: ____________________

Country: ___________________________ Zip/Postal Code: _______________________

Home Phone: __________________________ Business Phone: ______________________

Email: matouskovajana@hotmail.com

Affiliated PADI Dive Center/Resort: Dive Club Kassandra Store Number: 3481
Halkidiki, Hanioti GREECE

This eLearning Record verifies that the above student diver has successfully completed all of the knowledge development
requirements (knowledge reviews, quizzes and/or final exams) as required for the Open Water Diver Course
Section Quiz Score Date
Introduction 100 03/02/2010
Section One 100 03/09/2010
Section Two 91 03/16/2010
Section Three 92 06/08/2010
Section Four 100 06/21/2010
Section Five 100 07/02/2010
Course Exam Exam Score Date
Open Water Diver Course 98 07/02/2010

The fun is just beginning! If you haven't already contacted your affiliated PADI Dive Center or Resort to schedule your scuba
dives (practical application) do so today. You don't have to wait until you complete all knowledge development requirements
for your eLearning course.

Open Water Diver Course

Quick Review Completed: ____________________ Date: ______________

Instructor Name:_____________________ Signature _______________________ No. _______