Costa Rica Traveler Application & Recovery Support Profile

Costa Rica · May 7–14, 2027

Aerial view of a beachfront resort surrounded by rainforest and ocean

This confidential questionnaire helps us understand recovery support needs and plan a safe, welcoming experience.

Please send sensitive responses privately to Karen Vitale through an agreed secure channel, not a group email. Participation is subject to a private pre-trip conversation and suitability review. This is not a medical assessment or treatment program.

Eligibility Requirement

Guests must have at least nine (9) months of continuous sobriety by the trip departure date. Please provide your exact recovery date below.

This minimum is a program participation criterion, not a clinical guarantee of travel readiness.

About 15–20 minutes·Confidential·* Required

Section 01

Personal & Emergency Information

Full Name *

Preferred Name

Phone *

Email *

Emergency Contact *

Name

Relationship

Phone (with country code)

Preferred confidential method for Karen to contact you

Section 02

Your Recovery Journey

Exact sobriety / recovery date *

Total continuous sobriety at departure

Calculated from your date

Which substances or behaviors are part of your recovery plan? (You may discuss this privately.)

What does maintaining your sobriety mean to you today?

Have you experienced a return to use or significant recovery setback? What support helped? (Optional details.)

How stable and supported do you feel in your recovery? Any current concerns that may affect travel?

Section 03

Recovery Plan, Support & Relapse Prevention

What is your recovery plan? Please indicate what you have used and what you currently use: treatment facility, AA/12-step meetings, other peer support, sober living, private sober coach, therapy, medication-assisted treatment, or other. Include frequency and details you wish to share.

What helped you establish sobriety? What supports do you currently rely on, and who will remain available to you during the trip?

What are your early warning signs of stress, isolation, cravings or increased relapse risk?

What specific actions help you when a craving or difficult emotion arises?

Are there travel situations you want to plan for (airports, alcohol service, celebrations, free time, disrupted routines)?

If you feel at risk of returning to use during the trip, whom will you contact and what will you do immediately?

Section 04

Health, Medication & Travel Readiness

Do you have medical, mental health, mobility, dietary or accessibility needs affecting safe participation? Share sensitive details privately.

Do you take medications, including recovery medications, that must continue during travel? Have you planned for sufficient supply and international requirements?

Have you recently experienced withdrawal symptoms, detoxification, or a medical or mental health crisis? If yes, discuss privately before travel.

Is there a treating clinician or professional you would want contacted in an emergency? (Optional; separate consent may be required.)

Section 05

Personal Preferences & Private Coaching

What personal routines help you stay grounded (sleep, exercise, meditation, meetings, journaling, prayer, connection)?

What would you most like to gain from this sober travel experience?

Would you appreciate a private pre-trip conversation with Karen? What concerns or experiences would you prefer to discuss one-on-one?

During the trip, how would you prefer to request individual support from Karen?

Section 06

Travel Expectations & Acknowledgment

Personal responsibility

Your sobriety remains your responsibility. Each guest agrees to actively maintain sobriety, use their established recovery supports and relapse-prevention plan, and communicate promptly if additional support is needed. Guests are expected to respect an alcohol- and drug-free group experience and other travelers’ privacy.

Karen Vitale’s role

Karen Vitale of SoberLife-Coach accompanies the group as a non-clinical recovery coach. She is available for private one-on-one conversations, recovery concerns and confidential sharing throughout the trip, subject to practical availability and safety needs. Coaching is not 24-hour medical supervision, psychotherapy, detoxification or emergency care. Appropriate local emergency or medical services will be contacted when needed.

Privacy

Sensitive information should be discussed through a secure private channel and accessed only for legitimate planning or safety purposes, consistent with applicable law and consent arrangements. Confidentiality has limits, including emergencies and legally required disclosures.

What else should we know to help you participate safely, comfortably and confidently?

I confirm that the recovery date I provided is accurate, that I understand the nine-month minimum sobriety requirement, and that I have read the expectations above. This questionnaire does not replace a separate participation agreement, emergency consent or medical clearance when indicated. *

Guest signature (type your full name) *

Date *

This is not a medical assessment or treatment program.