Enrollment Form 

In order to prepare everything for you and set up a propper project plan, we need you to fill the following form as complete as possible. We will get back to you within 48 hours. Fields marked wit "*" are mandatory to fill.

Program / Course *

Prefered Start Date *

Prefered Duration of stay(weeks) *

For Spanish Courses, please indicate the modality *


Title *

First Name *

Last Name *

Address *

Town *

County / State *

Country *

Postcode / Zip *

Email *

Email you use
while travelling
(if different from above) *

Tel Home *

Tel Work

Occupation

Date of Birth *

Gender *

 Female     Male

Nationality *

 

If you do NOT want to receive email newsletters from ICARI, please un-tick this box. Please note we will NOT pass your information to any third parties. 



Emergency contact details

Name

Relationship to you

Tel Home

Tel Work

Email

Address



Passport details

Number

Place and date of issue

Expiry date



Health and Physical Fitness

Do you suffer from any of the following? Asthma, Epilepsy, Diabetes, Allergies

Do you take any prescription drugs or medication?
Have you had any psychological / psychiatric illness in the last three years?
If yes to any of the above, please supply more info below.
 

Do you have any dietary requirements?

Do you smoke?

Can you swim 200m unaided?

Do you have a criminal record?


If joining a marine expedition

Are you a qualified diver?
If yes, please state your qualifications and number of dives recorded.
 

 No. Dives 


If joining a marine expedition

Have you ever had a case (or suspected case) of DCS?
If yes, please provide details


 

Please introduce yourself to the course/ project staff by telling us a bit about your interests, previous
travel / volunteering experience, language skills, first aid, and any other relevant information or qualifications which might be useful. *
 

Please give your reasons for applying to join this course/ project. What do you hope to gain from it? *

Please tell us if you have any queries / concerns about the expedition / project which you are joining?
 

Where did you hear about ICARI? *

Have you been in an ICARI expedition before? (Tick if yes)  

If you would like to apply for more than one program, please complete a separate application form.
Thank you for your application. To ensure that you receive our emails, please add ICARI The Spanish School to your address book.