Student Name: Date of birth: Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Chichen Itza Full Day Excursion ($195.00 CAD) August program ONLY

Tulum & Playa del Carmen Full Day Excursion ($110.00 CAD)

Swimming with Dolphins (195.00)

Horseback Riding ($85.00) August program ONLY

Passion Island Full-Day ($95.00)

Snorkeling ($85.00 CAD)

Mexican Cooking Lesson and Dinner Soiree ($95.00 CAD)

Community Service Day ($95.00 CAD)

Optional excursions are non-refundable. Blyth Education (Blyth) reserves the right to cancel excursions and replace them with excursions of equal value. Students must comply with instructions from Blyth personnel and act in a safe and common sense manner. Neither Blyth nor its agents have any liability for injury, death or loss of or damage to property arising from a student's failure to act in accordance with the preceding sentence or from a student's negligence. Blyth reserves the right to prohibit a student from participating in an excursion at any time for health, safety, discipline or other reasons. All provisions of the Blyth brochure apply. We the undersigned have read and agree to the above terms.