Registration for Teens to Learn Spanish Language

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 can 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).

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

Click here for VISA REQUIREMENTS

Fields with asterisks are required *

*NAME:
*ADDRESS:
*EMAIL:
*TEL. #:
*AGE:
*COUNTRY:	SELECT>> United States Canada Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovi Botswana Bouvet Island Brazil UK Indian Ocean Terr Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Repu Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Terr Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard & Mcdonald Isl Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Democratic Republic Republic of Korea Kuwait Kyrgyzstan Lao Democratic Repub Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiri Liechtenstein Lithuania Luxembourg Macau FYROM Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Isl Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevi Saint Lucia Saint Pierre and Miq Saint Vincent Grena Samoa San Marino Sao Tome and Princip Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa S. Georgia Sandwich Spain Sri Lanka Sudan Suriname Svalbard and Jan May Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Isl Tuvalu Uganda Ukraine United Arab Emirates United Kingdom US Minor Outlying Is Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Virgin Islands (Brit Virgin Islands (U.S. Wallis And Futuna Is Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe
Which website, agency or other source did you find INTERCULTURA through?
MALE: FEMALE:
PASSPORT NUMBER:
*PARENT/GUARDIAN´S NAME:
*HOME PHONE #:
CELL PHONE #:
WORK PHONE#:
PROGRAM INFORMATION
ARRIVAL
DATE:	...
TIME:
AIRLINE
FLIGHT#:
DEPARTURE
DATE:	...
TIME:
AIRLINE
FLIGHT#:
CHECK 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)
WHERE AND HOW LONG HAVE YOU STUDIED SPANISH?:
	HOMESTAY, MEALS & ADDITIONAL INFORMATION
PLEASE STATE ANY PREFERENCES OR CONCERNS YOU MIGHT HAVE REGARDING (SMOKERS, CHILDREN, PETS, ALLERGIES, VEGETARIAN FOOD) AND ANY PHYSICAL PROBLEMS WE SHOULD BE AWARE OF:
PLEASE TELL US A LITTLE BIT ABOUT YOURSELF, YOUR LIKES AND DISLIKES, AND YOUR GENERAL EXPECTATIONS FOR THIS EXPERIENCE:
I have read and agree to abide by Intercultura's Cancellation and Refund Policy (click here to read):	* YES:

IMPORTANT:

Students must wait for their airport pick-up at the airport exit point. If you cannot find your family or driver, 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 in order 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 Intercultura Heredia or 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 / info@samaralanguageschool.com), and you must bring the actual credit card with you if you choose to use this payment method.