Temple Jeremiah

Application for Costa Rica June 14-21, 2018  

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We are thrilled that you are applying for the Temple Jeremiah Summer Break Trip to Costa Rica! All Temple Jeremiah 8th-11th graders are eligible to come on the trip. This trip is also open to non-members,  though at full cost.

Once you submit this application, Naomi Segal, Temple Jeremiah's Youth and Family Engagement Director, will contact you to set up an in-person interview. After the interview, she will give you the Temple Jeremiah and Putney agreement form. To hold your space on the program, you must return the signed agreement form and the $700 deposit by Friday, November 10, 2017. Checks may be made out to Putney Student Travel.

If you have any questions please contact Naomi Segal, Temple Jeremiah Youth and Family Engagement Director at naomi@templejeremiah.org or 847-441-5760, x 112.

Student Tuition for Temple Jeremiah members: $2,440 (final balance due by Dec. 15, 2017)
Student Tuition for non-members: $3,190 (final balance due by Dec. 15, 2017)
All inclusive tuition covers the flight, accommodations, food, activities, in-country transportation, and gratuities. Putney Student Travel will organize group flights between Chicago and Liberia, Costa Rica. Trip cancellation insurance and medical evacuation insurance are available for an additional fee.
Application Timeline
  • Friday, November 10, 2017: Application, signed agreement form, and $700 deposit check due to Temple Jeremiah.
  • Friday, December 15, 2017: Tuition balance and airfare due to Putney Student Travel. 

Pre-Trip Programming
Before we leave in June, our group will meet three times between January and May. These times will be decided once our group is finalized. The meetups will include team-building exercises, brief Spanish lessons, a history of Costa Rica and the culture, and creating a group project that we will bring back to our community after the trip.

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Teen's Information

Teen's Information

Contact Information

Parent's Information
Parent/Guardian One

Parent/Guardian Two

Parent's Information
Parent/Guardian One

Is the address the same as the student's? yes/ no
If no, please provide the additional address information:

Parent/ Guardian Two

Is the address the same as the students? yes/ no
If no, please provide the additional address information:

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Student's Background Information

Application Questions

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Temple Jeremiah and Putney programs are designed to bring teens out of their comfort zones, to enable them to experiment with increased levels of independence, and to immerse them in new environments. 

We recognize that parents know their children and can be their best advocates. In order to ensure that each participant has a successful experience, regardless of needs, we strive to build positive partnerships with families. We rely on you to respond honestly to the questions below so that we can begin an open dialogue about our ability to support your teen.
There are some basic expectations that we have of our participants that help ensure that our program is safe for all involved. We expect that all Costa Rica trip participants...

-- Are willing to participate in all program activities (volunteering, educational sessions, etc.).
-- Are able to understand and follow multi-step directions.
-- Are able to communicate their needs.
-- Will not require one-on-one supervision or shadowing.
-- Will not wander from the group.
-- Will not threaten harm to themselves, or engage in self injury.
-- Will not threaten harm or be violent or physically aggressive to others.
-- Will maintain a healthy diet while on the program to ensure that they stay nourished and hydrated.
-- Are able to manage their own self hygiene.
-- Will be able to manage any challenges they may have with the skills they have learned in their home setting.
-- Will approach new situations and communities with respect, an open mind, and sensitivity toward other cultures.

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Thank you fore applying for the Temple Jeremiah Youth Trip to Costa Rica! You will be contacted within the next business day for an interview. If you have any questions, please contact Naomi Segal, Temple Jeremiah Youth and Family Engagement Director at naomi@templejeremiah.org or 847-441-5760, x 112. 

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