Questionnaire / Application

First Name(required)

Last Name(required)

Email(required)

Phone Number(required)

Facebook or Instagram profile page

Street Address(required)

City(required)

State(required)

Country(required)

Age(required)

Status (student, employed, etc. – provide details, such as school/employer name, location, phone number, contact person, etc. If employed, position and responsibilities)(required)

Emergency Contact Name, Phone #, Relationship(required)

Travel Status(required)

Alone With companion(s)

If with companion, name & relationship (companion should submit separate questionnaire)

Level of Proficiency in Spanish(required) None Basic Intermediate Proficient Fluent

Level of Proficiency in English(required) None Basic Intermediate Proficient Fluent

What date would you like to begin work on the farm?(required)

How long would you like to work with us? (2 week minimum - 3 month maximum)(required)

Have you traveled to Central America previously?

Yes No

Tell us about your skills that will be of benefit to us on the farm.(required)

Rate your experience in using hand tools (shovel, hoe, rake, hammer, etc.)

1 – No Experience 2 3 4 5 Experienced

Rate your experience in the kitchen for meal preparation from scratch (we do not use processed food - nothing frozen, nothing from a box or a can – only fresh fruits, vegetables, dried beans, grains, etc.)

1 – No Experience 2 3 4 5 - Experienced

Places, dates, contact info of other places you have done a work-stay exchange(required)

What best describes your diet (select closest ONE only)

Vegan Raw Vegan Fruitarian Vegetarian Pescatarian Omnivore

If Vegetarian or Vegan, how long?(required)

Dietary restrictions or food allergies?(required)

Do you understand that we consume only vegan meals on the farm, we do not cook with oil, we do not cook with salt, at times we have no refrigeration, and NO animal products whatsoever are to be brought to or consumed on the farm?

Yes No

Do you smoke cigarettes?

Yes No

Do you smoke marijuana?

Yes No

Do you consume alcohol?

Yes No

If so, how much and how often?

Physical limitations, medical conditions (physical or mental), or conditions for which you are medicated:(required)

Do you have any veterinary background or training?(required)

Would you feel comfortable staying on the farm in the absence of the owner?(required)

How did you learn about our farm?(required)

planetcostarica.com facebook web search or other

Any other information you would like to share?(required)

By checking this box and submitting this application, I affirm that: (i) I am at least 18 years of age, am in good health for travel and physical work, and that the information provided is true and complete; (ii) I have read and agree to the Terms and Conditions of participation in a Planet Costa Rica work/stay program as outlined on this website; and (iii) I understand that if I am accepted to the program, any false statements, omissions, or other misrepresentations made by me on this application, or insubordinate or disrespectful behavior while on the farm may result in termination of the arrangement without refund. Payments are non-refundable. If you feel you may not be able to make the trip, please do not make the commitment. If you are worried that unforeseen events may cause you to cancel your trip, please consider purchasing trip cancellation insurance. In the event you can not make your trip, you may reschedule for a later date, subject to availability. Otherwise, please consider lodging payment made as a donation toward the food and care of the animals. If you arrive and do not stay for the entire time committed, no refund will be given.(required)

Submit

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