Costa Rica with Shaina Group Mandatory Booking Form

Directions: You must fill out this form online.

Please fill out one form per room UNLESS each person is paying separately then each person will need to fill out their own form.

Once you hit submit, a confirmation email will be sent to you.

If you are interested in a single room for an additional cost, please call Travel Haus @ (215) 723-8687. These rooms are limited.

I WILL BE PAYING by the following method. I understand my initial $450 PER PERSON deposit MUST be paid by check or cash only. Checks should be made out to Travel Haus Inc. and mailed immediately upon submission of this booking form. If we have not received your deposit check within 2 weeks of this form being submitted, your space will be canceled. I understand all payments after my deposit will be made by the same method as I choose below. Travel Insurance can be paid in the same check as your initial deposit if purchasing insurance with your deposit. Otherwise, you will pay for the travel insurance at time of final payment with the method you choose below.*

Double Room (both guests paying together)$5,998.00

Price for 2 adults sharing 1 room and paying together

Confirm Pricing for your final payment

Double Room (each guest paying separately)$2,999.00

Price for 1 adult sharing a room with another adult and each person paying separately

Confirm Pricing for your final payment

Total $0.00

NAME 1: (EXACTLY AS IT APPEARS ON YOUR PASSPORT)*

First NameMiddle NameLast Name

NAME 1: BIRTHDATE *

Enter Month, Day & Year

NAME 2: (EXACTLY AS IT APPEARS ON YOUR PASSPORT)*

First NameMiddle NameLast Name

NAME 2: BIRTHDATE *

Enter Month, Day & Year

I will be rooming with (this guest is paying separately):*

ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

YOUR CELL NUMBER WHILE TRAVELING*

Area CodePhone Number

EMAIL for confirmations & trip communications*

If you do NOT have an email type none@none.com

EMERGENCY CONTACT NAME (a person NOT traveling with you)*

Enter name here

PHONE NUMBER FOR YOUR EMERGENCY CONTACT ABOVE*

Area CodePhone Number

PASSPORT COPY (can be provided later). You will need to provide Travel Haus with a copy of your passport no later than November 30, 2025. All passports MUST be valid through October 1, 2026

Browse Files

UPLOAD HERE

PASSPORT COPY for Traveling Companion (can be provided later).

Browse Files

UPLOAD HERE

Do you have any dietary restrictions/allergies/medical needs we should be aware of? Travel Haus will try our best to accommodate any special needs.

TRAVEL INSURANCE

This is NOT a cancel for any reason insurance

Travel Haus recommends that you purchase an Allianz travel protection plan to help protect you and your travel investment against the unexpected. The protection plan we recommend, provides coverage for Trip Cancellation, Trip Interruption, Trip Delay, Emergency Medical Expenses, Medical Evacuation/Repatriation and more. For more information or to review the description of coverage prior to purchase, go to:

https://acrobat.adobe.com/link/review?uri=urn:aaid:scds:US:f627a4ae-58f7-34a5-b009-e0823c453f9f

Please Note: You may purchase coverage up to the trip final payment date. You MUST be medically fit to travel when you purchase the plan.

Terms, conditions, and exclusions apply to all plans. Insurance benefits underwritten by BCS Insurance Company (OH, Administrative Office: 2 Mid America Plaza, Suite 200, Oakbrook Terrace, IL 60181), rated “A” (Excellent) by A.M. Best Co., under BCS Form No. 52.201 series or 52.401 series, or Jefferson Insurance Company (NY, Administrative Office: 9950 Mayland Drive, Richmond, VA 23233), rated “A+” (Superior) by A.M. Best Co., under Jefferson Form No. 101-C series or 101-P series, depending on your state of residence and plan chosen. Plans only available to U.S. residents and may not be available in all jurisdictions. Allianz Global Assistance and Allianz Travel Insurance are marks of AGA Service Company dba Allianz Global Assistance or its affiliates. Allianz Travel Insurance products are distributed by Allianz Global Assistance, the licensed producer and administrator of these plans and an affiliate of Jefferson Insurance Company. The insured shall not receive any special benefit or advantage due to the affiliation between AGA Service Company and Jefferson Insurance Company. Plans include insurance benefits and assistance services. Any Non-Insurance Assistance services purchased are provided through AGA Service Company. Except as expressly provided under your plan, you are responsible for charges you incur from third parties. Contact AGA Service Company at 800-284-8300 or 9950 Mayland Drive, Richmond, VA 23233 or customerservice@allianzassistance.com.

INSURANCE CHOICE - It is mandatory for all of our travelers to have Emergency Medical insurance that covers both emergency evacuation and repatriation to the sum of $200,000 USD. Insurance rates are subject to change until paid for. Once you pay for your insurance, it is NONREFUNDABLE. If you reside in a state other than Pennsylvania, your rates may be different. You will be advised if they are different. THIS IS NOT A CANCEL FOR ANY REASON INSURANCE*

I would like to purchase a STANDARD TRAVEL PROTECTION PLAN INCLUDING TRIP CANCELLATION and am paying with my initial deposit so coverage begins immediatelyI would like to purchase a STANDARD TRAVEL PROTECTION PLAN INCLUDING TRIP CANCELLATION and will pay with my final payment. I understand that coverage will not begin until my premium has been received by Travel Haus. Pre-existing medical conditions are covered as long as I pay by my final payment date.I would like to purchase an ON TRIP ONLY TRAVEL PROTECTION PLAN and will pay with my final payment. THIS PLAN DOES NOT INCLUDE TRIP CANCELLATION AND IS OFFERED THRU ARCH/ROAMRIGHT INSURANCE. This plan will include the required emergency and repatriation insurance to enter Costa Rica. I understand if I cancel my trip before departure I agree to assume any risk, and take full responsibility for all costs associated with any loss of, or change to, my travel arrangements. I understand this could result in the loss of my travel investment and/or require more money to correct the situation. This insurance is only for coverage during your trip.I choose to decline insurance coverage and agree to assume any risk, and take full responsibility for all costs associated with any loss of, or change to, my travel arrangements. I understand this could result in the loss of my travel investment and/or require more money to correct the situation. I also acknowledge without insurance, there may be no way to recoup any loss. I also understand that I MUST have proof of Emergency Medical insurance that covers both emergency evacuation and repatriation to the sum of $200,000 USD or I will not be allowed to enter Costa Rica. I understand that Travel Haus is NOT responsible if declining our insurance and if you do not have appropriate documentation or insurance coverage to enter Costa Rica.

INSURANCE COVERAGE AMOUNT - You MUST cover your entire trip cost. You may NOT underinsure. If purchasing the standard coverage which includes trip cancellation, please click the appropriate option based on if you chose the cash or check price for your trip or the credit card price for your trip.*

$263 per person - Standard Coverage INCLUDING TRIP CANCELLATION up to $3000 per person if you chose the CASH OR CHECK PRICE$303 per person - Standard Coverage INCLUDING TRIP CANCELLATION up to $3500 per person if you chose the CREDIT CARD PRICE$41 per person -(ages 18-34) - On Trip Coverage ONLY. NO TRIP CANCELLATION INCLUDED.$49 per person - (ages 35-49) - On Trip Coverage ONLY. NO TRIP CANCELLATION INCLUDED$52 per person - (ages 50-59) - On Trip Coverage ONLY. NO TRIP CANCELLATION INCLUDED$66 per person - (ages 60-69) - On Trip Coverage ONLY. NO TRIP CANCELLATION INCLUDED

BY TYPING MY NAME, I AGREE TO THE TRAVEL HAUS TERMS & CONDITIONS. Typing your name constitutes an electronic signature. which is legal and enforcable in the same fashion as a traditional signature.

Once you have submitted your form, Travel Haus will place your booking on hold. We must receive your deposit check within 14 days of your submission or your space will be released.

ELECTRONIC SIGNATURE:*

Type your signature here

Once you hit submit, a confirmation email will be sent to your inbox and your registration is complete.

Travel Haus, Inc

614 E. Broad Street, Souderton, PA 18964

(215) 723-8687

Groups@TrvlHaus.com www.TrvlHaus.com