Habla Language Services Registration Form for Costa Rica Spanish Immersion Program

Costa Rica Spanish Immersion Program Application

Apply for the Spanish Immersion Program 2023 in Costa Rica by filling the form below, specify the expected number in your party (sharing 1 hotel room).
Each adult participant must submit a separate registration form, a liability waiver form, a Tardiness Agreement form (on the Before you Go Packet), and a $600 non-refundable deposit to reserve your spot. Remaining balance is due no later than June 12, 2023.

Also, make sure you have a valid passport for international travel.

If your application is approved, we will request your deposit and send you confirmation and the "Before You Go Packet." Once you have your confirmation, you should begin to make your travel arrangements. Travel/Health Insurance is HIGHLY RECOMMENDED and should be purchased soon after paying the deposit.

Also, please keep in mind that the best time to see animals and birds is in the morning. The culture of Costa Rica is early to bed and early to rise. If you are a night owl or looking for night life, this is not the trip for you. Also, you will stay with a host family in relatively humble conditions for 5 nights. Apart from that, we move to a different hotel room every night, so please be prepared to be portable and travel for a few hours each day in the passenger van.

We will do our best to make sure your primary goals are met. For example:
- I'm working on my Spanish!
- I'd love to see a sloth
- I'm looking for adventure
- I want to explore new things
- I want to meet new people
- The rain forest is on my bucket list
What are your main goals for the program?*
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Number of people attending in your party*
Name of other people in your party

First NameLast Name
Name of other people in your party

First NameLast Name
Name of other people in your party

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Emergency Contact*

First NameLast Name
Phone Number of Emergency Contact*
Emergency Contact*

Email AddressRelationship
PASSPORT INFORMATION
All trip participants MUST have a valid passport that will be valid during the entire stay.
Name on Passport   First Name*   Last Name*
Passport Number   Number*
Issued at    City*   Country*
Date of Issue   Date*   Expiration   Date*
INFORMATION FOR PARTICIPANT #2 (if applicable)
Name on Passport   First Name*   Last Name*
Passport Number     Number*
Issued at     City*     Country*
Date of Issue      Date*   Expiration   Date*
If you do not have a valid passport, it is your responsibility to apply for or renew your passport at a post office or passport office. Once you receive your new passport, you must provide Habla Language Services with the information above as well as a photocopy of the first page of the passport no later than 30 days prior to departure.
Spanish Competency Levels
Do you know the Spanish Basics: Greetings, numbers, colors, day, months, question words?*
Can you speak Spanish in the present tense?*
Can you speak Spanish using the past tense?*
If you are more advanced, please explain your communication abilities and your current goals.
How would you rate your Spanish SPEAKING level?*
How would you rate your Spanish LISTENING level?*
How would you rate your Spanish READING level?*
How would you rate your Spanish WRITING level?*
Medical and Personality Information
If you or your child(ren) have health conditions, allergies, take medication or have a personal situation of any kind that you would like us to know about (especially anything that may influence your travel experience), please describe them below. This information can be helpful in the event of an emergency and will be kept confidential unless emergency medical treatment is needed.
Physician Full Name

First NameLast Name
Phone Number
What is your occupation? Interests/Hobbies?*
Have you traveled overseas?*

YesNo
If yes, where?
How to you feel about change?*

I'm flexible, no problem.I am o.k. with change if the reason is explained to me.I like structure and I like to know what we will be doing and when.
Comfort Zone*

Bring it! I love challenges and will leave my comfort zone.If it seems safe, I'm all for it.Baby steps. I don't like to leave my comfort zone.
Diet*

I love trying new foods especially when in a new country.I have a special diet I need to or prefer to adhere to. (If this is checked please make sure specifics are noted in Medical Section.)I prefer my pizza and hamburgers and other familiar foods.
Fitness Level*

I can easily hike over 10 miles with hills.I like moderate walks around 3 miles, not too steep.I have mobility issues or prefer not to walk much.
Activities I'd love to participate in (check all that apply)*

Animal Observation & EducationNature Walks/HikesSpa Treatments and/or relaxationFoodCultural ActivitiesAdventure: Horseback riding, white water rafting, zipliningShoppingOther
Host Family Questions
Have you ever stayed with a host family?*
Can you live with children?*
Do you smoke?*
Do you drink alcohol?*
Do you want to share host family accommodations with anyone?*
Do you have any food allergies or special diet?
Do you need any accommodations for the homestay and/or the trip?
Costa Rica Tourism Liability Waiver

I agree and acknowledge that I am undertaking such participation in the Costa Rica Tourism Program as my own, free and intentional act, and I am fully aware that possible physical injury, though unlikely, may occur as a result of my participation. In the event of any related circumstances, I will not hold Habla Language Services, nor any of its agents responsible nor liable. I give this acknowledgement, freely and knowingly, and that I am as a result, able to participate in the Costa Rica Tourism Program. I do hereby assume full responsibility for my own well-being.
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Costa Rica Spanish Immersion Program Application

Spanish Competency Levels

Medical and Personality Information

Host Family Questions