RIDERS COSTA RICA TRIP APPLICATION

______   TRIP FOR AGES 16-18: JUNE 16 - 25, 2008 

______   TRIP FOR AGES 13-15, JULY 21 - 30, 2008

To sign up for one of the the Riders Costa Rica trips, please print, fill out, and sign this application, and mail it with your deposit check for $1125. Applications are processed on a first come, first served basis. Please send
your application to:

The Art Farm, P.O. Box 1976 Bridgehampton, NY 11932

Name...................................................................................................................

First nameLast Name

Address................................................................................................................

StreetCity       State          Zip

Home Phone (      ).................................Email......................................................

Birth Date................................................Height.....................Weight....................

School...................................................Grade completed at start of trip...................

Mother’s Name.......................................Father’s Name..........................................

Business Phone (     )...............................Business Phone (     )..................................

Cell Phone (     ).....................................Cell phone (    )........................................

Email....................................................Email.......................................................

Do you have any dietary restrictions? If so, please explain:..........................................

...........................................................................................................................

Do you plan on attending with a friend? .....Yes .....No Name................................

Is the applicant, or has the applicant in the past 24 months been under the care of a physician, psychologist or psychiatrist? .....Yes ......No

Is there any information about your child’s physical or mental health that might have some bearing on his/her trip with The Riders? .....Yes .....No

If yes to either of these questions, please explain on a separate sheet of paper.

Please list any prescribed medications the applicant is currently taking or has taken in the past 24 months on a separate sheet of paper.

Surfing Skills:.......beginner .......intermediate.......advanced   # of years experience.......

Spanish Skills:.......beginner .......intermediate.......fluent        # of years experience.......

My son/my daughter is enthusiastic about participating in The Rider’s trip to Costa Rica. We also understand that a fulfilling and enjoyable experience with The Rider’s depends upon a positive attitude, a desire to contribute positively to the whole group, and a willingness to participate in all activities. All photos and video footage taken during the trip can be used for promotional purposes.

We further understand that the use or possession of any form of tobacco, any alcoholic product or any illegal drug as well as any inappropriate behavior may result in the immediate return home, without a refund and at your cost of any applicable travel fees. Upon receipt of your application and deposit, a waiver and medical forms will be sent to you and must be returned before the start of the trip.

Participant’s signature............................................................................................

Parent’s signature..................................................................................................