JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Middle & High School Intercultural Program Registration 2024
In order to complete registration, one must...
1. Fill out this form
2. Email goticocostarico@gmail.com the following:
PDF of signed Liability Waiver
Confirmation of payment
Copy of passport
3. V
enmo
@goticocostarica 50% of program fee (please send email/whatsapp +506-8991-3536 once payment made for confirmation)
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Student Name
(First, Last)
*
Your answer
Student Email
*
Your answer
Student Phone Number (all communication will be done through WhatsApp)
*
Your answer
Student Birthdate
(DD/MM/YY)
*
Your answer
Student Graduation Year
*
Your answer
Student Address
(Street, City, State, Zip)
*
Your answer
Guardian Name
(First, Last)
*
Your answer
Guardian E-Mail
Your answer
Guardian Phone Number (all communication will be done through Whatsapp)
*
Your answer
Guardian Address
(Street, City, State, Zip)
*
Your answer
Emergency Contact Name (First, Last)
*
Your answer
Emergency Contact Phone
*
Your answer
Emergency Contact E-Mail
*
Your answer
Emergency Contact Relationship
*
Your answer
Frequent Flyer numbers (if applicable - please indicate company)
Your answer
Dietary Restrictions
Your answer
Allergies
Your answer
Medical Conditions, Medications, Treatment Plan
Your answer
Anything else we should know while you travel with us?
Your answer
How did you hear about our student trips
*
Word of mouth
Social Media
Direct Email
Google
School Email
Other:
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of UW-Madison Google Workspace.
Report Abuse
Forms
