• Student Pre-Registration for a Humanitarian Dental Service Trip to Guatemala

  • THANK YOU for your interest in participating in a Dental Services Trip to Local Hope's Open Wide Legacy Dental Clinic in the Guatemalan Highlands!

    If you are a student with valid ID, you are welcomed to use this brief pre-registration form requiring just a $525 non-refundable deposit to hold your spot. Please noted that:

    Students: Save My Spot Only!

    1. Current Student ID is required

    2. Child discounts will not be available when you complete registration.

    3. The Pre- and Post-night discounted bookings usually arranged at the Barcelo by Local Hope ($120 including a full buffet breakfast) may not be available.

    4. Your completed full registration form must be filled out and balance paid prior to the required Group Orientation for this trip (approximately 60 days prior to travel). 

    Local Hope, known in Guatemala as Xela AID Partnerships for Self Reliance, is a 501 (c) 3 non-profit charitable organization federally registered in the United States, EIN #45-3658025. 100% of the proceeds from your contribution will fuel empowerment programs! As such, your contribution may be fully tax deductible. Please consult your tax professional.

     

    Let's Get You Pre-Registered! 

  • Select a Trip to Join or List Your Own (Options to Extend will appear on your full registration form)
  • If You Are Proposing Your Own Week, Please List Your ARRIVAL Date in Guatemala City (Note: Your Departure Date will the same week-day the following week)
     - -
    2 digit month, 2 digit day, 4 digit year
  • PART 1 - TERMS & CONDITIONS

  • GUEST PLEDGE AGREEMENT

     
    A - Etiquette at Local Hope's Xela Aid Campus

    OUTLOOK - To set a good example while in the village of San Martín Chiquito, I will bring my best to each day, including my enthusiasm, patience, a listening ear and an open heart.

    RESPECT - I will recognize as my equal and show respect for each member of the Xela AID staff and village residents, and will strive to do so with those in my group to help ensure an outstanding service experience.

    SEEK HELP - Should I take ill, become injured, overly anxious, frustrated or experience any other issue that interferes with my experience, I will seek the help of a Xela AID staff member to quickly resolve the issue.

    SAFETY - I will follow safety guidelines shared with me by my Xela AID staff contact in Guatemala.

    SUBSTANCE USE - To minimize risks and to avoid modeling behaviors that could be deleterious to the health and well-being of those we serve, no smoking, vaping, or use of recreational drugs is allowed on the premises of the Xela AID Complex. Additionally, in all cases and despite local jurisdictions or the law in a participant's state or country of origin, the drinking age at Xela AID Campus is 21 years of age. It will further be expected that all participants refrain from over-drinking that could result in injury to themselves or others.

    B - Health - Keeping Yourself and Our Community Safe

    HEALTH - If I have cold or flu symptoms during my experience, including a runny nose, fever, headache, cough, or other symptoms, to protect the staff and village community, I agree to mask, wash my hands frequently, and take related precautions and understand I may be asked by staff to do so. If asked, I will comply.

    INSURANCE - Your package does not include health or trip cancellation insurance, which some guests choose to purchase. Please consider your overall health, and the likelihood of circumstances arising that could cause you to have to cancel your trip. (See our Refund Policy to further inform your decision on this option.)

    C – Restricted Activities to Honor Our Diverse Constituency and Avoid Misunderstandings About Our Mission

    • NO DIRECT CASH GIFTS PLEASE - We have learned that charity has unintended consequences. As our guest, we encourage you to reward the excellent experience you’ve had through our tipping system. You agree, however, that you will not give cash gifts directly to staff, participants in our programs or their families on or off-campus. If you are inspired to help, you’ll do so most effectively by supporting one of our established empowerment programs. See our Director or Deputy Director to select a program close to your heart!

    • AVOID POLITICS PLEASE - Politics is divisive the world over. As our guest you understand that political activities are not appropriate on our premises, and as a requirement of your stay, you agree that you will not conduct or participate in them. Please avoid political discussions that could distract from our common-good mission work. 

    • HONORING DIVERSE VIEWS - We honor diverse world views, and as such, we welcome religious as well as secular groups to our Xela Aid Campus to gather and to serve. Out of respect for all our diverse community and to avoid the appearance of our organization advocating a specific religion or belief system, proselytizing, requiring participation is not allowed on our premises nor as part of activities we arrange for you within the communities we serve. A moment of silence for people to give thanks in their own way is welcomed.

  • Part 2 - STUDENT PARTICIPANT INFORMATION

  • Format: (000) 000-0000.
  • Student Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
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  • YOUR DEPOSIT TODAY 

    The Deposit you are paying today will be credited toward your full Registration. If you fail to complete Registration, it will by applied to Empowerment Programs at Local Hope, and you will receive a tax receipt by January 31. When you complete Registration, you will use this coupon (which you'll also be reminded of at check-out on during Registration):  

    LocalHope525

  • Deposit Only*

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    Student Deposit. (For one student only)
    Student Deposit

    (For one student only)

    $525$525
      
    Total
    $0.00$0.00
  • Part 3 - REFUND POLICY, TAX DEDUCTIBILITY

  • Refund Policy

    Local Hope is a not-for-profit 501(c)(3) organization. Please note that 100% of your contribution fuels our empowerment programs! Your $525 is non-refundable deposit should your plans should change. If you believe your plans could change for any reason, we strongly advise that you purchase trip cancellation insurance.

  • Part 4 - IMPORTANT - Please Save Below Before Submitting

    TO AVOID DATA BEING LOST SHOULD FOR ANY REASON YOUR CREDIT CARD FAIL, WE STRONGLY SUGGEST THAT YOU SAVE THIS DOCUMENT PRIOR TO SUBMITTING TO PAY. A LINK TO RE-ACCESS WILL BE SENT TO YOU BY EMAIL. WE REGRET THAT WE CANNOT SAVE YOUR SPOT UNTIL THIS SUBMISSION HAS BEEN PAID FOR AND RECEIVED. We look forward to your visit!
  • Payment Methods

    Choose from one of the PayPal options to make your payment.

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