Registration Form

Register to Learn the Spanish Language

For our Intensive Adult Spanish courses, simply fill in the following form, then return it here on-line, by email, fax, or call us with your registration information. For the summer Teen Spanish & Adventure program, click here to register. Before you register, please review Costa Rica's National Holidays as classes are not held on these days, and Visa Requirements.


Fields with asterisks are required *


PERSONAL INFORMATION
       
*First and Last Name: *Email:
Gender: Male:    Female:    
*Age: Minimun Age 18 ***Except if registering for the Teen Program***
*Tel: Fax:
*Emergency contact Name: *Emergency contact Number:
Profession: Passport Number:
   

Address
*Street: City:
State/province: Postal code:
*Country:    
       

MARKETING INFORMATION
       
Which website, agency or other source did you find INTERCULTURA through?
*Internet sources:
*Print and Media Sources:
Other:
       
AIRPORT PICKUP INFO
 
Pick me up at the airport: Yes: No:
Date:   
   
Time:
Ariline:
   
Flight #:
Which Airport:
    

SPANISH PROGRAM
       
  Length of Program desired for both Campuses (weeks):  
 
NOTE: Classes start Monday and end Friday each week. Tuesday is the latest day to begin a course.
       
Class dates in Heredia  (City Campus)     
From:     To:    
       
Class dates in Samara (Beach Campus)    
From:     To:    
       
Approximate 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)
       

HOMESTAY INFORMATION
       
Would you like Homestay?:     Yes           No:    
 
Start in Heredia Homestay
From:     To:    
     
Start in Samara Homestay from:  
From:     To:    
     
Homestays run from Sunday to Sunday. Additional nights can be booked for up to 4 nights, after this you will be charged for the weekly rate.
 
Would you like to be the only
foreign student in your family?:     Yes           No     

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 accommodations
  • 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.

    		•
     

    HOTEL INFORMATION (Sámara campus only)
     
    If you would like to choose the HOTEL Option in Sámara, instead of a Homestay, please fill in the following:
    Hotel Start date:       Hotel End date:   
           
        2-Star Hotel     3-Star Hotel
        Single Room     Double Room
        Triple Room     Other:     
         5-Night Stay (In Sunday, out Friday)      7-Night Stay (In Sunday, out Sunday)

    VOLUNTEER PROGRAM INFORMATION

    For students registering for our Volunteer Program please fill out the following section. Volunteers must complete a minimum of two weeks of study at Intercultura. Most positions require intermediate fluency or higher, though there are some exceptions to this. The volunteer program placement and orientation fee is $175.
    Volunteer Program
    Start Date:    		 Volunteer Program
    Start Date: 
           
    Estimated Spanish
    Level at Time of
    Placement:    		  
    Desired Placement (See Volunteer page options)    
    First Choice:    
    Second Choice:    
    Third Choice:    
       

    ADDITIONAL COMMENTS

    Please feel free to provide any additional information you feel relevant in the space below:
       
    I have read and agree to abide by Intercultura's Cancellation and Refund Policy (click here to read) and the penalities described in the Important Information below. I am aware of the National Holidays and Visa
    * YES:
       
    SECURITY CODE
       
    * PLEASE INPUT THE SECURITY CODE DISPLAY BELOW (REQUIRED)
       


    IMPORTANT INFORMATION

    AIRPORT PICK-UP INFORMATION (BOTH CAMPUSES):
    Students who request airport pick-up must wait for their families or taxi 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. If you are flying into Liberia (LIR) and have requested taxi pick-up, 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 Liberia airport pickup, but rather take an airport taxi directly, which will cost approximately $100 from Liberia to Sámara.
    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, you will need to send us your credit card number and expiration date in order to guarantee your reservation. If you do not cancel at least 3 days before arrival, you will be charged a penalty fee of $50.
         
    SPAM/JUNK MAIL FILTERS:
    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. If after submitting your registration you do not hear back from us within 3-5 business days, please contact us again at info@interculturacostarica.com or info@samaralanguageschool.com or call us at:
     
    Costa Rica Direct line: +(506) 2260-8480 / 2656-0127
    Toll Free US/Canada: 866-978-6813
    Local number US/Canada: 213-402-0426
    Local number Europe: 44-20-3318-3142
    		  
     
    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 (you must bring actual card), or in the event of a no-show (info@interculturacostarica.com or info@samaralanguageschool.com)


    NATIONAL HOLIDAYS: School is closed on these dates
     
    2010
    JANUARY 1st:
    		 New Years Day
    MARCH 29th to APRIL 2nd:
    		 Easter Week
    APRIL 11th:
    		 Juan Santamaría Day (Costa Rica's national hero)
    MAY 1st:
    		 Costa Rican Labour Day
    JULY 25:
    		 Annexation of Guanacaste
    AUGUST 15th:
    		 Mother's Day
    SEPTEMBER 15th:
    		 Costa Rican Independence Day
    OCTOBER 12th:
    		 "Día de la Raza" Indigenous Peoples' Day
    DECEMBER 12th to 26th (2010)
    		Christmas Holiday
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    INTERCULTURA, Costa Rica, Language School & Cultural Center
    Address :
        P.O Box 1952-3000, Heredia Costa Rica, Central América
    E-mai :
    Tel/Fax :
        +(506) 2260 8480 / 2656 0127
    TOLL FREE NUMBERS :
        USA/Canada :     866-978-6668 / 213-784-4897
        Europe            :     44-20-7993-0822