Waldorf San Diego – Costa Rica

Student Traveler Form

Participant/Student Name (as it appears on passport)(Required)

First Last

Do you have a preferred name (if different from passport name):

Yes

If yes, please write in your preferred name

Students date of birth(Required)

Passport Number(Required)

Passport Expiration Date(Required)

Important: If your passport expires within 6 months of your departure back home, you need to renew it.

Photo of passport(Required)

Max. file size: 128 MB.

Known allergies of student, including allergies to medicines:

Please write “NA” if none.

Any other medical problems which should be noted:

Please write “NA” if none.

Date of last tetanus booster

Family physician name:

Family physician phone:

Parent/Guardian Name(Required)

First Last

Parent/Guardian Email(Required)

Parent/Guardian Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Person to notify if parent/guardian is unavailable(Required)

First Last

And their phone(Required)

Student Ice Breakers

You wake up famous overnight — what are you famous for?(Required)

⁠If you had to delete all apps except three, which survive?(Required)

What are you most looking forward to on your trip to Costa Rica?(Required)

PARTICIPANT RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS, AND INDEMNITY AGREEMENT

Costa Rican Resource, Global Trails, and Pacuare Outdoor Center

Because adventure travel and outdoor activities involve inherent risks, we recommend that you supplement your own insurance policies with travel insurance.

In consideration of the services of Costa Rican Resource, Global Trails, and Pacuare Outdoor Center, and their agents, owners, stockholders, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf, I, the undersigned, acknowledge and agree that:

The risks from the activities involved in this trip are significant. These risks include but are not limited to, loss of or damage to personal property (including personal vehicles and their contents parked or transported while on the trip), injury or fatality during transportation by bus, boat, or other vehicle, slips, trips, and falls while hiking or participating in activities, immersion in water and possible hypothermia, exposure to airborne pathogens and viruses including but not limited to COVID-19, accidents occurring in remote areas without immediate access to medical facilities or personnel, errors in food or water storage or preparation, encounters with animals, insects, and wildlife, and exposure to temperature extremes or inclement weather. I also understand and acknowledge that failing to use or properly use safety equipment when provided increases my risk of injury or of not surviving an accident or incident.

I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF COSTA RICAN RESOURCE, GLOBAL TRAILS, AND PACUARE OUTDOOR CENTER OR OTHERS, TO THE FULLEST EXTENT PERMITTED BY LAW. I ASSUME FULL RESPONSIBILITY FOR MY PARTICIPATION IN THIS TRIP. Furthermore, should emergency rescue, medical services, or evacuation become necessary, the expenses are my responsibility and not that of Costa Rican Resource, Global Trails, and Pacuare Outdoor Center.

I, for myself and on behalf of my parents, my heirs, assigns, personal representatives, and estate, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS COSTA RICAN RESOURCE, GLOBAL TRAILS, AND PACUARE OUTDOOR CENTER, their agents, owners, stockholders, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF COSTA RICAN RESOURCE, GLOBAL TRAILS, AND PACUARE OUTDOOR CENTER OR OTHERWISE, to the fullest extent permitted by law.

I also hereby agree that Costa Rican Resource, Global Trails, and Pacuare Outdoor Center may use film or photographic records of this trip for promotional purposes. I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily.

The venue of any dispute that may arise out of this agreement or otherwise between parties, to which Costa Rican Resource, Global Trails, and Pacuare Outdoor Center or its agents is a party, shall be Turrialba, Costa Rica.

Parent/Guardian Signature(Required)

I give my permission to Costa Rican Resource personnel, to seek treatment in a medical emergency for the above-named student. This includes being admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize licensed physicians, dentists, technicians or nurses to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment for the above minor.

Parent/Guardian Signature(Required)

Photo and Video Release

I grant to Costa Rican Resource the right to take photographs/videos of me to be used by CRR in their publications and or websites. The photo/videos will not be digitally manipulated to change its content, nor will my last name be used or printed. (If you are under 18yrs., a parent or guardian must sign.)

Signature