High School Spanish Immersion in Costa Rica

High School Spanish Immersion Travel Registration

Whether you’re joining us in Costa Rica or Ecuador – You are going to love your experience

Have your passport*, medical insurance, and emergency contact information handy to complete this program registration.
If for some reason you have not made your non-refundable program deposit yet, please make that deposit now (this deposit applies to your immersion program fee). Your space on the program is not reserved until you make your deposit.
Once you’ve completed this registration and your initial deposit, participants will receive access to our online pre-departure course with tons of necessary information about the trip, a few travel contracts to sign, and a payment schedule for the balance of your program. This course opens in Jan. Stay tuned for more details.

*You absolutely need a passport for travel to Costa Rica & Ecuador. Passport fields are not “Required” fields on this registration form, so you will still be able to submit your registration even if you don’t have a valid passport currently.

2023 High School Spanish Immersion Registration

We're excited to have you join us on our Spanish immersion program! Please fill out this application in its entirety and submit.

Today's Date
MM slash DD slash YYYY
How did you hear about this program?*
Do you remember if you were searching online... some sort of advertisement... social Media... a presentation, a family or friend?
Select your Immersion Program*
Do you have custom travel dates?
Please detail length and dates of the trip you've pre-approved with Common Ground leadership
Student Information
Student Name (As on passport)*
First Middle Last
Student Phone*
Student Email*
Gender Identity*
Date of Birth*
Age at time of program start?*
Address
Street Address City State ZIP Code
Parent/Guardian 1 Information
First Name*
Last Name*
Last
Relation to Student*
Cell Phone*
Email*
Does parent/guardian 1 live at the same address you entered above?*
- Yes
- No
Please provide parent/guardian 1 address
Street Address City State ZIP Code
Parent/Guardian 2 Information
First Name
Last Name
Last
Relation to Student
Cell Phone
Email
Does this parent/guardian 2 live at the same address you entered above?
- Yes
- No
Please provide parent/guardian 2 address
Street Address City State ZIP Code
Emergency Contact Information (not Parent/Guardian)
Full Name*
Relation to Student*
Email*
Cell Phone*
Address
Street Address City State ZIP Code
Passport Information
Is your passport issued by the United States of America?*
- Yes
- No
What is the nationality/citizenship stated on your passport?
First Last
Name Exactly as on Passport
Passport Number
Date of Issue
Please enter this date as it is on your passport: Month, Day, Year
Month
Day
Year
Date of Expiration
Please enter this date as it is on your passport: Month, Day, Year
Month
Day
Year
Medical Information
Primary Care Physician*
Phone Number*
Medical Insurance Carrier*
Policy Number*
Health Conditions*
Please list and describe any & all health conditionsthat student has. This information is extremely important for us to know to keep your student healthy and happy while abroad. We keep this information strictly confidential.
Medications*
Please list and describe any & all health conditionsthat student has. This information is extremely important for us to know to keep your student healthy and happy while abroad. We keep this information strictly confidential.
Allergies*
Please list any and all allergies to food, insects, medications, etc. Does this participant carry an epipen?
Special Dietary Needs
Please list all special food requirements that student has.
ECUADOR PARTICIPANTS*
It is imperative we know about any and all mental, physical, health factors and medications. We will be out on the trail for 4 days. It is important that we know what we are dealing with in case of any emergencies. Things that might not come to mind but are super important are... - a heart condition -Asma - a severe allergy that requires an epi-pen (insects, food, medications) - a tendency to get overwhelmed and "give-up" Please be detailed in your description below
Has the participant completed the COVID - 19 Vaccination?*
Has the participant completed the COVID - 19 Vaccination?* Please select "yes" if 100% done, "No" if not at all, & "Other" and provide detail if you've not completed your vaccination regimen.
- Yes
- No
COVID - Underlying Conditions*
Please list any underlying conditions the participant has that may complicate health if participant were to contract COVID 19 while abroad.
Host Family Information
Do you prefer a family with or without children?*
- With Children
- Without Children
Do you need any special accommodations at your host family?*
Spanish Language Experience
Briefly Describe your Spanish experience*
Please include number of years of Spanish in high school, any related foreign travel, etc.
What Spanish class / level are you currently in?*
Can you comfortably communicate in the present tense in Spanish?
- Sí
- No
Can you comfortably communicate in the past tense in Spanish?
- Sí
- No
Can you comfortably use commands in Spanish?
- Sí
- No
Can you comfortably communicate using the subjunctive in Spanish?
- Sí
- No
Oral Comprehension*
Speaking Proficiency*
Reading Comprehension*
Writing Ability*
Statement of Purpose / Interest in Immersion Program
Please explain why you wish to participate in this program and what you hope to gain from it.*
High School Information
Name of High School*
Name of Spanish Teacher
Spanish Teacher's Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Character References
Participants...we need two references that know you well and can speak of your character, school and community involvement. Please include one teacher and another adult. Please do not include an immediate family member, rather someone from your community (teacher, coach, church, work, etc..Please submit two character reference letters along with this form. You will need to copy and paste the link below in your browser and download this form to follow instructions: https://commongroundinternational.com/wp-content/uploads/2018/01/Character-Reference-Form.pdf
Reference # 1 Name*
How do you know this person?*
Email*
Phone*
Reference # 2 Name*
How do you know this person?*
Email*
Phone*
Thank you for submitting your travel registration form.
We will be in touch with you with next steps. Be sure to hit the submit button below!

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Travel Registration – High School Spanish Immersion

High School Spanish Immersion Travel Registration

Whether you’re joining us in Costa Rica or Ecuador – You are going to love your experience

Notes about this Spanish immersion registration for parents & students:

2023 High School Spanish Immersion Registration

Student Information

Parent/Guardian 1 Information

Parent/Guardian 2 Information

Emergency Contact Information (not Parent/Guardian)

Passport Information

Medical Information

Host Family Information

Spanish Language Experience

Statement of Purpose / Interest in Immersion Program

High School Information

Character References

Thank you for submitting your travel registration form.

If you have any trouble completing this registration form, please contact us, we will be happy to assist you.