Booking Form

About You

Name *

First

Last

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

We will send a medical Spanish book to this address

Email *

Cell Phone *

Existing employment or studies *

Please tell us a little about what you are doing now, so we can provide the best possible program for you.

Your Program Here

Where possible please choose a start date as the first Monday of your chosen month.

Start date (Monday) *

You are welcome to stay with your host family from the Saturday before your program begins

End date (Friday) *

Program Type *

Medical Spanish & clinical elective
Medical Spanish only

Medical Spanish program option *

Medical Spanish (4 hours per day)
Intensive medical Spanish (7 hours per day)

What is your existing level of Spanish *

Beginner
Intermediate
Advanced

On arrival to Trujillo, you will take a Spanish language placement test to determine the most appropriate group for you

Rotations *

Preferred department (In order of preference) *

Any accommodation preferences at your family home stay

Travel Insurance *

The Medical Elective Network travel insurance
My own travel insurance

We include travel insurance as part of our program. Please confirm if you would like to use this travel insurance or if you have your own policy.

Payment Preference

Please confirm whether you wish to receive a deposit invoice or a single invoice for the full program cost. We ask that payment for either option be made within two weeks.

Deposit invoice of $250
Invoice for full program fee

General Questions

Please let us know if you have any questions about any aspect of your program.

Where did you hear about us? *

Please tell us where

Terms of Service *

I have read and agree to the terms of service listed below

Travel Insurance
We include travel insurance covering health, accidents, and theft. If you prefer to use alternative travel insurance, we need to see confirmation of this before your arrival.
We need you to have travel insurance during your stay in Peru for your protection.

Information Use
We may need to pass on some of your personal information to one or more contractual partners (e.g., homestay families) to fulfill the course that you have booked or comply with legal requirements (e.g., immigration authorities).
Sometimes we photo or video program participants for our publicity material. If you object to this, please advise us when you arrive.

Payment
Please pay 100% of the fees at least four weeks before the course. The payment deadline is necessary as we must make payments to third parties, including host families and hospitals.

Change to booking
To make any changes regarding your booking (e.g., change of course date or accommodation), please do let us know at least four weeks in advance.

Complaints
We aim to provide you with the best possible experience and will attempt to resolve any complaint quickly and efficiently. Please advise us immediately of any concern you have.
In the event of a legal dispute, the case shall be heard under the sole jurisdiction of the courts of Peru.

Cancellations and Curtailment by the Client
If you cancel your booking, please let us know by email as soon as possible. The following cancellation structure applies.

Cancellation fee before the start date:
The first $250 of your program payment is nonrefundable. We will refund 100% of the remainder of any payment that has been made.

If you decide to curtail your program once it has begun, we will not pay any refunds, and you will be responsible for any additional costs involved.

Public Holidays
Classes and clinical rotations do not take place on Peruvian Public Holidays.

Your Responsibilities
To provide all the information, we request to arrange your clinical placement. This includes your resume, proof of vaccinations, travel insurance, and proof of your existing student program or professional employment.

You are required to arrive punctually and participate in the clinical placement and language lessons as agreed.
You are required to respect the rules of the medical facilities you attend and those of your accommodation provider.
You must pay for any damage you cause at your clinical facility, elective center, or homestay accommodation.
If your behavior is disruptive or offensive, we reserve the right to expel you with immediate effect, and no refund will be provided in such circumstances.

Spam check *

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