Checking off your bucket-list, one trip at a time

COSTA RICA TRAVEL FORM

Personal Information

Name

First Name

Last Name

Birth date:

Emergency

Emergency Contact:

First Name

Last Name

Relationship:

Contact Number (including country code)

Arrival Information

Do you have a valid Visa to enter Costa Rica?

Prism Adventures is not liable for any visa-related issues

YES

Date of Arrival to San Jose airport

YYYY

Time of Arrival to San Jose Airport

(please include a.m. or p.m.)

Flight Number

Please add Flight Number arriving to Venice Airport

Departure Information

Date of Departure from San Jose Airport

YYYY

Time of Departure from San Jose Airport

(please include a.m. or p.m.)

Flight Number

Please add Flight Number departing from Venice Airport

Fitness and Medical History

What is your physical fitness level?

Please list previous medical/psychological conditions which may affect your fitness level

Please list any medications you are taking

Please list any medication allergies

Please provide any additional information that may be useful to emergency medical personnel in the event of an emergency

COSTA RICA FORM