Sister Communities of San Ramón, Nicaragua

Through Ecotours and Community Involvement the Sister communities of San Ramon are dedicated to giving back to the Nicaraguan Community.

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Supplemental Information Form

Supplemental Information Form

Supplemental Information Form

This form is to collect necessary travel info after a participant has completed the Reservation Form, including flight, medical insurance, and emergency contact info. Please complete and return this form as soon as possible, but no later than 60 days prior to the date of your trip departure. WE WILL REFUND YOUR DEPOSIT AND YOU WILL NOT BE ALLOWED TO PARTICIPATE IF WE HAVE NOT RECEIVED THIS FORM BY 60 DAYS PRIOR TO DEPARTURE.

Step 1 of 5

20%

Participant's Name
First Last
Departure Date*
MM slash DD slash YYYY
Is the participant a minor?
- Yes
- No

Flight Information
Arrival to and departure from the Managua airport
Arrival Date
MM slash DD slash YYYY
Arrival Time

: Hours

Minutes

AM/PM
Airline
Flight Number
Departure Date
MM slash DD slash YYYY
Departure Time

: Hours

Minutes

AM/PM
Airline
Flight Number

Emergency Contact Information
Emergency Contact
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Work Phone
Cell Phone
Email

Medical Insurance Information
General Medical Insurer
Policy number
Insurer contact phone number
MedEvac Insurer
Policy Number
MedEvac Insurer contact phone number

Known Health Conditions
I have previously informed SCSRN of any physical or mental health condition of the participant named above that I believe SCSRN or Finca Esperanza Verde should be aware of that might restrict engagement in rigorous physical activity (i.e. injuries, asthma, etc.) or that could be triggered by the stress of international travel.
- Yes
- No
Certification Regarding Medical Preparation [Adults]
I have prepared for the trip by conferring with my physician and obtaining all appropriate inoculations and medications. I am aware of what each insurer requires me to do to receive coverage for any medical attention I require while on the trip.
- Yes
- No
Certification Regarding Medical Preparation [for a Minor]
I am responsible for the minor participant named above. I confirm that the minor has received all appropriate inoculations and medications. I am aware of what each insurer of the minor requires the minor to do to receive coverage for any medical attention the minor might require while on the trip. I confirm that I have arranged to communicate with such insurers on behalf of the minor and they recognize my authority to deal on behalf of the minor. If I am not the parent or legal guardian of the minor, I also possess a Power of Attorney or other authorization appropriate to enable me to make health care decisions for the minor in the event of illness or injury.
- Yes
- No
Change in information provided
I will notify Sister Communities of San Ramón, Nicaragua by telephone and email if any of the above information becomes incorrect. Any cancellation refund due to any incorrect information or changes to information will be as provided by the cancellation policy stated in the Reservation Form.
- Yes
- No

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What We Do

• We support the people of San Ramón, Nicaragua in community-led initiatives, prioritizing local solutions to local problems.
• We build cross-cultural relationships of friendship, respect, and mutual understanding through cultural immersion ecotours.

Travel With Us

“This program creates opportunities for basic needs to be met… one school room at a time, one disabled children’s clinic at a time, one clean safe water system at a time, and on and on.” – Thanksgiving Ecotour participant
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