Intercultura Costa Rica Registration form

To register, simply fill in the following form, then return it here on-line, by mail, fax, or call us with your registration information.

Please advise us of your flight date, airline, number and arrival time so that we may be at the airport to meet you (if you do not yet have this information, you may send it to us separately at a later date). Extra fees apply for airport pick ups, please inquire.

** Please see the National Holidays listed at the end of this form before submission.**

Fields with asterisks are required *

*NAME:

*EMAIL:

*ADDRESS Street:

City:

State/Province:

Postal code:

*TEL. #:

FAX #:

*AGE:

<< Minimum age 18 >>

*Except if registering for the Teen Program*

MALE:

FEMALE:

*COUNTRY:

PROFESSION:

PASSPORT NUMBER:

Which website, agency or other source did you find INTERCULTURA through?

*Internet sources:

*Print and Media Sources:

*Other:

PICK ME UP AT THE AIRPORT:

YES:

NO:

DATE:
TIME:
AIRLINE
FLIGHT#:
WHICH AIRPORT:

LENGTH OF PROGRAM DESIRED FOR BOTH CAMPUSES (weeks):

NOTE: Class dates should start on a Monday and end on a Friday. Homestay dates should be Sunday to Sunday, unless requesting additional days at the end of your stay (extra cost per night)

Classes date in Heredia (Main Campus). From:

To:

Classes date in Samara (Main Campus). From:

To:

SPANISH LEVEL:

	COMPLETE BEGINNER: (no previous Spanish study)
	MID-BEGINNER: (present tense, simple sentences, basic comprehension)
	INTERMEDIATE: (future, past, present tense, some conversation)
	ADVANCED: (subjunctive, reading, writing, conversation)

WOULD YOU LIKE A HOMESTAY?:

YES:

NO:

Start in Heredia Homestay from:

To:

Start in Samara Homestay from:

To:

IMPORTANT NOTE: Students who reserve a host family in either campus and then cancel their stay with less than 2 weeks notice will be subject to a penalty fee of $50. This applies both to 'no-shows', and to students who decide to stay at one campus instead of moving to the other campus as initially planned. For example: if you book 2 weeks in Heredia followed by 1 week in Sámara, but during your time in Heredia decide to stay there and cancel your stay in Sámara, you will be charged the $50 homestay-cancellation penalty.

NOTE: If you would like to guarantee your place in the beach campus, please register now for your beach dates. If you do not do so, you may still attend, but on a space- available basis.

Would you like to be the only foreign student in your family?:

YES:

NO:

If you would prefer the HOTEL OPTION (5 nights per week) in Playa Sámara, please indicate this in the notes below. Please also indicate if you are willing to share a room, if a roommate is available. If you wish to be alone, or if no roommate is available, you will need to pay an additional $50 per week directly to the hotel.

Please state any preferences you might have regarding your homestay (children, pets, smoking, vegetarian food, etc) and any relevant physical concerns we should be aware of. In addition, in order to help us match to a homestay suitable for you, of the following five characteristics, please list the two which are most important to you:

· Cleanliness and standard of accomodations
· Communication and interaction with family
· Family that lives close to school
· Family with children
· Quantity and quality of food/cooking

ADDITIONAL COMMENTS:

Emergency contact Number:
Emergency contact Name:

IMPORTANT:

Students who request airport pick-up must wait for their families at the airport exit point. If you cannot find your family, please use the emergency contact numbers you have to call the family and/or the school. Do not take a taxi or leave the airport until you have spoken to a school representative or the family. The school will not reimburse students who leave the airport without waiting for their family or contacting us first. You can make a collect (reverse charge) call by dialling 110, or you can ask the taxi drivers to change a small bill into local money for you to use a payphone. Alternately, we suggest renting a cel phone before you leave home, at www.costaricacellularconnection.com or a similar company.

If you would like to rent a cel phone for use in Costa Rica, click here

Please make sure that spanish@interculturacostarica.com and info@samaralanguageschool.com are included in your list of accepted correspondents (White List), so that your spam filter does not reject our emails when replying to your correspondence.

CREDIT CARD NUMBER: Please call or mail Samara Language School your credit card information in order to guarantee your reservation. Nothing will be charged to your card until you arrive, or in the event of a no-show. (info@interculturacostarica.com)

SCHOOL WILL BE CLOSED ON THESE DATES:

NOTE: On the following dates classes will not be held at Intercultura, due to National Holidays and professional development scheduling. There are no discounts for these days, so please review carefully before registering. Homestays are not affected by the holidays. Those holidays which fall on weekends do not affect your stay. For each holiday there are different cultural activities in which we encourage students to participate. Holidays that fall between Tuesday and Thursday may be moved to Friday in order to give a long weekend.

2008
JANUARY 1:	New Years Day
MARCH 17th to 21th:	Easter Week
APRIL 11:	Juan Santamaría Day (Costa Rica's national hero)
MAY 1:	Costa Rican Labour Day
JULY 25:	Annexation of Guanacaste
AUGUST 15:	Mother's Day
SEPTEMBER 15:	Costa Rican Independence Day
OCTOBER 12:	"Día de la Raza" Indigenous Peoples' Day
December 15 to December 19:	Professional Development Week
DECEMBER 22 (2008) to January 2 (2009):	Christmas Holiday

Location II Spanish Instruction II Beach Campus II Cultural Activities II University Credit II Volunteer Opportunities II Homestays II Price List II Registration Form II References II Photos II Staff II Contact Us II EFL Program II HOME
INTERCULTURA, Costa Rica, Language School & Cultural Center
Address.	P.O Box 1952-3000, Heredia Costa Rica, Central América
E-mail.	contactus@interculturacostarica.com
Tel/Fax.	+(506) 2260 8480 / 2656 0127
TOLL FREE NUMBERS	USA/Canada: 866-978-6668 / 213-784-4897
	Europe: 44-20-7993-0822

Web Design By:

DOCTOR WEB