Summer Ecotour for Teachers Reservation Form

Trip includes all lodging, all meals, all activities, workshops and performances, in-country transportation by private coach and in the back of a pickup truck, where the group will experience the local culture and living conditions.
Enrollment is limited and based on a first come-first served basis. We reserve the right to cancel the trip fewer than 6 people enroll 60 days prior to departure.
No later than 60 days prior to the scheduled departure date of an Eco-tour SCSRN must receive for each Participant a Supplemental Information Form with the required information, that will be sent to the participant by email after completing the reservation form. A separate Supplemental Information Form will be required for each Participant, including minors.
IMPORTANT: MEDICAL INSURANCE. San Ramón is in a remote area. Many medical insurance policies (including government insurance) might not pay for some or all medical and related expenses when outside of the United States. All Participants are required to obtain “MedEvac” insurance to cover emergency transportation and medical care in case of illness or injury. Proof of coverage must be provided as required in the Supplemental Information Form no later than 60 days prior to the departure date. There are many providers of MedEvac insurance. A list of insurance providers that offer MedEvac insurance has been provided to your Trip Organizer. Each Participant is responsible for investigating insurance products and selecting one appropriate for a trip to Nicaragua and return. SCSRN has no responsibility under any MedEvac insurance policy and is not affiliated with any MedEvac insurer. This reservation form must be provided by each Participant.
I have read and understand the information above.*
- Yes
Name of Trip*

Participant's name as it appears on passport:*
First Middle Last
Passport Number
Why do we need this information? The Institute of Tourism of Nicaragua, in conjunction with Nicaraguan Immigration Services, requires all tourism service providers to keep a registry of the people they serve: hotels, transportation providers, etc. This is in order to track and detain criminals that take advantage of the relatively lax tourist visa requirements (tourist visas cost $10, and are automatically granted to people entering the airport with a valid passport). Also, in order to travel internationally, a traveler’s return date must be within six months of the expiration of his/her passport.
Date of Expiration of Passport
Email*

Allergies
Participant is allergic to the following food, medicine, bug or bee bites. SCSRN does not maintain or administer medicines for treatment of allergies or allergic reactions.
Participant’s special dietary requirements
- Vegetarian
- Vegan
Participant’s Spanish speaking ability*
- Good
- Fair
- None
Date of Birth*
Why do we need this information? If your group will be buying your plane tickets together, he or she will need your date of birth in order to purchase the block of tickets. Also, age and gender helps us for placement with host families in San Ramon.
MM slash DD slash YYYY
Participant's Gender
- Male
- Female

Please list any physical or mental health condition of Participant that you believe SCSRN should be aware of.
Include any conditions that may restrict engagement in rigorous physical activity (i.e. injuries, asthma, etc.). Also please note that international travel may present a departure from your normal physical and emotional comfort levels; you might find it to be stressful.

Participants are asked to let SCSRN know before departure if you experience any physical or emotional health conditions that may affect your ability to cope with the stress of travel so that we can discuss your concerns further. SCSRN reserves the right to prohibit participation due to concern about health issues.
8. If you have goals for the trip different from what is planned for the group, please describe:
Transporting Materials
One way that travelers support our work is by helping us transport materials to and from San Ramon. If you are willing to do this, please check all that apply:
- I can offer my help transporting a suitcase of material aid (medicine, books, etc.) from Durham to San Ramón.
- I can bring back to Durham a suitcase of crafts or other items.
- I can bring back to Durham a suitcase of honey weighing 48 lbs.

Additional Information
Plane travel to Nicaragua is limited. Participant will make and pay for Participant’s own plane reservations immediately or as soon as possible and understands that (i) Participant must be in the Managua Airport no later than 2 pm on the first day of the Eco-tour and (ii) Participant’s flight departing Nicaragua must leave Managua no sooner than 1 pm on the last day of the Eco-tour.

Reimbursement for Flight
- SCSRN will notify you when your Reservation Form has been received, and you can proceed to buy your plane ticket. Upon purchasing your ticket, send your ticket receipt to SCSRN and you will be reimbursed up to $750.
- When purchasing your ticket, we request that you purchase flight insurance, in case of cancellations. If a cancellation should occur and the airline reimburses your flight, you will be expected to reimburse SCSRN for the cost of your flight.
The Participant’s signed Participation Agreement is attached. Please sign and mail to: SCSRN, P.O. Box 766, Durham, NC 27702
By clicking SUBMIT, I hereby agree to the terms listed in this reservation form, and declare that all the information included is true to the best of my knowledge.
Phone
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Summer Ecotour for Teachers Reservation Form

Step 1 of 5

Additional Information

Reimbursement for Flight

By clicking SUBMIT, I hereby agree to the terms listed in this reservation form, and declare that all the information included is true to the best of my knowledge.

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