PFL Costa Rica Application

Application Form - Prescription for Love - COSTA RICA

Los Sueños, Costa Rica | February 12-19, 2024 | $3,750 CAD per couple
Applicant's Full Name*

First NameLast Name
Spouse's Full Name*

First NameLast Name
Applicant's Birth Date*

DayMonthYear
Spouse's Birth Date*

DayMonthYear
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
E-mail*
Phone Number*
Emergency Contact*

First NameLast Name
Emergency Contact Relationship*
Emergency Contact Phone Number*
Health Details

In order for us to best serve each participant on the retreat, please answer the following questions. All answers will be kept strictly confidential.
Do you or your spouse have any serious medical conditions we should be aware of?*
PHYSICAL LIMITATIONS: Please advise if physically disabled or handicapped, under a doctor’s care, taking any medication, have a heart condition, diabetes, high blood pressure, or suffer from back or neck pain. If this does not apply to you or your spouse, please write N/A.*
DIETARY RESTRICTIONS: Do you or your spouse have any dietary restrictions/allergies? (Please note, all meals will be plant-based - no meat, dairy, or eggs).*

NoneGlutenNut(s)SoyOther
ALLERGENS: Please list non-dietary allergens (if any) and any other comments you think are necessary.
If you have any questions that you wish to discuss prior to participating in the retreat, please do so before committing yourself to the program.

By submitting this form, you agree to the following:

1. I understand and agree to the Terms & Conditions.

2. I have a valid passport.

3. My passport is valid for 6 months after the Marriage Enrichment Retreat.

4. I understand that I will need to have my deposit and final payment made per the Terms & Conditions.

5. I realise that retreats held by It Is Written Canada require my mental and physical health, and I certify that I am fit to undertake it.

6. I acknowledge that I have voluntarily applied to participate in the Marriage Enrichment Retreat. I am voluntarily participating in the trip with the knowledge that travel to foreign countries may involve some inherent risk.

7. RELEASE: I acknowledge that the cost of the Marriage Enrichment Retreat is based upon trip participants executing this Release of Liability and Assumption of All Risks. Therefore, as a lawful consideration for being permitted to participate on such trip(s), I hereby RELEASE AND DISCHARGE IT IS WRITTEN CANADA AND ITS AGENTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL LIABILITY ARISING FROM MY PARTICIPATION IN THE TRIP. I agree that this release shall be legally binding upon myself, all minors under the age of 21 traveling with me, my heirs, successors, assigns and legal representatives, it being my intention to fully assume all the risk of travel and to release It Is Written Canada from any and all liabilities to the maximum extent permitted by law. I understand that all applications are subject to acceptance by It Is Written Canada and upon acceptance shall be deemed legal.

8. KNOWING AND VOLUNTARY EXECUTION: I have carefully read and fully understand the contents and legal ramifications of this agreement as well as all the conditions as stated in terms and conditions. I understand this is a legally binding and enforceable contract and agree to it on my own free will. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.

9. I understand the cost is $3,750 CAD per couple and does not include booked air travel. I also understand that a 10% deposit of $375 is required before my application will be accepted. I have these funds and am ready to have someone contact me to make a secure payment.
Initials*

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Thank you.

Someone from It Is Written Canada will contact you for payment once your application has been reviewed.
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Application Form - Prescription for Love - COSTA RICA