*NAME:

*EMAIL:

*ADDRESS:

*TEL. #:

FAX #:

*AGE:

Minimum age 18

***Except if registering for the Teen Program***

*COUNTRY:

PROFESSION:

PASSPORT NUMBER:

Which website, agency or other source did you find Samara Language School through?

PICK ME UP AT THE AIRPORT:

NOTE:
Class dates should start on a Monday and end on a Friday.
Homestays dates should be Sunday to Sunday, unless requesting additional days at the end of your stay (extra $18 per night).

IMPORTANT

AIRPORT PICK UP INFORMATION (LIBERIA INT'L AIRPORT):
If you chose to have the school pre-arrange transportation with a provider from Sámara, they will be at the airport at the time and day you indicate. If you do not arrive on this time/day, for whatever reason, you will be charged the full amount of the pickup, to be paid directly to the taxi, as he will have already made the journey to the airport. NOTE: If you prefer not to be potentially responsible for this charge, you should NOT choose to have airport pickup, but rather take an airport taxi directly, which will cost approximately $100.
HOST FAMILY FEES: 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 fee.

HOTEL INFORMATION (PLAYA SÁMARA):
If you have chosen hotel accommodations, to guarantee your reservation you will need to send us your credit card number and expiration date. If you do not cancel at least 3 days before arrival, you will be charged a penalty fee of $45.

CLASSES DATES IN HEREDIA
(MAIN CAMPUS)

CLASSES DATES IN
SAMARA BEACH
(BEACH CAMPUS)

SPANISH LEVEL:

WOULD YOU LIKE A HOMESTAY?:

Start date in Heredia homestay:

Start date in Samara homestay:

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

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.

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:

 

To help us find you a host family that will be a good match for you, try to describe your ideal homestay family in 1 to 3 lines maximum. If you wish, you may also tell us a few things about you that might help us to get to know you better. And, from the list below, please indicate which two 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

Please remember that we cannot guarantee your requests, but we will do our best to match you accordingly, within the families available at the time.

 

ADDITIONAL COMMENTS:

* Emergency contact Number:

* Emergency contact Name:

I have read and agree to abide by Intercultura's Cancellation and Refund Policy (click here to read):

* YES:

Please send us a picture or yourself (small head shot, in low resolution) via email to spanish@interculturacostarica.com (Heredia students) or info@samaralanguageschool.com (Beach campus students). This will help your host family & school staff identify you for airport or other meeting points.

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.

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.