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YUM KAX HIGH SCHOOL PROGRAM APPLICATION
Personal Information

Name
Last Name
Sex
Birth Date
Nationality
Apt# / Street 
City
State and Postal Code
Country
Telephone (Home)
Telephone (Work)
Fax
E-mail
Telephone # and name of a responsible person for emergencies
Passport #


YUM KAX Details
Name of your teacher
Name of your High School
Date you wish to start  
# of weeks
Select the plan in which you wish to enroll
Spanish level
Do you wish to do part time volunteer work? Yes No


Family
Special dietary needs No
Vegetarian
Others 
I would rather live with a family with children
without children


Medical
Do you have any medical problem? No  Yes 
Do you have any allergies? No  Yes 


Travel
Would you like to be met at the airport? Yes  No
If yes, answer the questions below
Which Airport?
Airline
Flight#
Date of arrival
Time of arrival (Guatemalan Time)


Payment
You wish to pay by: Bank Transfer (Please contact our USA Office to get our account #)
Check (indicate check number, amount, date and send to our USA office)
Total amount of check (US$)
Number of check
Date sent by mail

If we do not receive your check within 8 days, your name will be automatically deleted. If you are accepted, we will e-mail you a confirmation. Please do not forget to send us all the neccesary items listed on the requirements page.


Inquiry

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Where did you learn about Casa Xelajú?
How do you wish to receive your booking confirmation? E-mail
Regular Mail
Fax

Comments and sugestions will be appreciated.

Thank you for your interest in Casa Xelajú

I acknowledge that I have read and understand the conditions presented and understand my financial obligations which begin upon receipt of my confirmation, and that I have my parent's authorization.