Wilton – 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.

Which year are you attending the Wilton Costa Rica trip?

2026

2027

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)

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)

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)

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(Required)

Waiver

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

Pacuare Outdoor Center and Global Trails

Because river trips involve risks, we recommend that you supplement your own insurance policies with vacation insurance. Cancellations made within 30 days of a trip departure date are non-refundable.

In consideration of the services of Pacuare Outdoor Center, Global Trails, and their respective agents, owners, stockholders, officers, volunteers, participants, employees, contractors, affiliates, and all other persons or entities acting in any capacity on their behalf (collectively referred to herein as the “Released Parties”), 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 shuttled while on the trip), injury or fatality due to capsize or collision of boat, injury or fatality while riding in a bus or shuttle vehicle, air loss from boats, falling out of a boat, collision with a vehicle, vessel, rock, log or tree, immersion in water and hypothermia, exposure to airborne pathogens and viruses, including but not limited to contraction of COVID-19, falling while aboard a vessel or on shore, ankle or knee injury from use of footcups, errors in food or water storage or preparation, accident or illness in remote places without medical facilities or personnel, water damage to personal property, 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 such as personal flotation devices or helmets increases my risk of injury or of not surviving an accident or incident while rafting.

I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF ANY OF THE RELEASED PARTIES 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 those of the Released Parties.

I, FOR MYSELF AND ON BEHALF OF MY PARENTS, HEIRS, ASSIGNS, PERSONAL REPRESENTATIVES, AND ESTATE, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE RELEASED PARTIES WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY, WHETHER ARISING FROM THE NEGLIGENCE OF ANY OF THE RELEASED PARTIES OR OTHERWISE, TO THE FULLEST EXTENT PERMITTED BY LAW.

I also agree that Pacuare Outdoor Center and Global Trails may use film or photographic records of this trip for their 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 the parties, to which Pacuare Outdoor Center, Global Trails, or their respective agents are parties, shall be Turrialba, Costa Rica.

Signature(Required)