High/Middle School Form Casa Xelajú

Name & Last Name *

Date of Birth *

Sex:MaleFemaleOther

Email Address *

Phone *

Emergency Phone & Name

Street Address *

Passport# (If you have it) & Nationality *

Interests/Hobbies

Studies

Are you traveling alone or with a group?AloneGroup

Name of chaperone

StudiesHigh SchoolMiddle School

Do you wish to receive college credits?Yes ($15 for handling paper work when applying for college credits)No

If Yes, answer How many credits do you wish to obtain? and name of the University.

What kind of credits are you applying for?College CreditsOthers

Please specify

Language Level

Languages (find your Level Written/Verbal) Spanish Level)

Native Language

Other Language

Have you studied Spanish?YesNo

If yes, answer where and how long?

Home-Stay Information

Family Special dietary needsVegetarianVeganNoOther

If checked other

I would rather live with a familyWith ChildrenWithout ChildrenPetsNo Pets

Health

Allergies

Medical problems

Comments and suggestions would be appreciated

I understand that in addition to the $100 deposit, I am required to pay half of the cost of the trip prior to departure and the remainder upon arrival. You can pay the tuition, rent and other services ahead of time via Paypal (julio@casaxelaju.com) or Venmo (@julio-batres-7). Please make the payment as a family/friend. Otherwise, these services will charge 3% of your payment, personal check to Julio Batres (4701 Zenith Ave. S., Minneapolis MN 55410). Any questions?. Total amount to advance (US $) *I've read terms and conditions

High/Middle School

If you do not receive a confirmation in two days, please text or call us +1 612 353 1809, WhatsApp +502 39976461

Studies

Language Level

Home-Stay Information

Health