Registration Form

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* Required Fields

Personal Info

Participant Name*

Nickname

Gender*

Male Female

Current Grade*

Date of Birth*

School*

Participant Email

First Parent/Guardian

Parent/Guardian Name*

Home Address*
City*
State*
Zip*

Home Phone*

Business Phone

Cell Phone

Fax

Email Address

Second Parent/Guardian

Parent/Guardian Name

Home Address
City
State
Zip

Home Phone

Business Phone

Cell Phone

Fax

Email Address

How did you hear about EarthConnect?

Preferred Means of Contact
What is your preferred method of receiving future information packets and forms. Please check each medium through which you would like to receive information.
Mail--mailings will be sent to address listed above for Parent/Guardian #1 (unless otherwise requested)
Email (check all who apply)
       Parent/Guardian #1
       Parent/Guardian #2
       Participant

Airline Information
Costa Rican Adventures will be coordinating a group flight on Continental Airlines. Participant will depart from the city requested below, and all flights will connect in Houston, where a Costa Rican Adventures staff member will accompany the group flight to Costa Rica.
Departure City (1st choice)
Departure City (2nd choice)
Departure City (3rd choice)

Please click on the following link and check below if you agree to it: Rules, Regulations, and Policies
*I have read, understand, accept, and agree to abide by these terms and all Costa Rican Adventures rules, regulations, and policies

A $500 deposit is needed to complete your registration.
I will mail a check for $500 (payable to Costa Rican Adventures) to the below address
I will make a payment online (follow the link to our online payment page after clicking “Submit”)

Please contact us with any questions or comments at:

Costa Rican Adventures
2721 Shattuck Ave, Suite 214
Berkeley, CA 94705
Toll Free: 800-551-7887
Phone: 510-922-9585
Fax: 510-922-9586

earthconnect@costaricanadventures.com