Challenger Learning Center New Mexico - Albuquerque, New Mexico

REGISTRATION FORM

1. Positions in programs are not guaranteed until payment has been received by CLCNM.
2. Payment for all missions is due 1 week before flight date.
3. All fields are required (*). If you cannot complete a field, please enter "NA" (Not Applicable).

Student Information All Fields Required

Student Name *

School *

Entering Grade *

Address *

City *

State *

Zip *

Phone *

Mother's Name *

Mother's Phone *

Father's Name *

Father's Phone *

Email *

Emergency Contact Information All Fields Required

Emergency Contact *

Phone *

Relationship *

Special Needs All Fields Required

Allergies *

Special Needs *

Programs | Holiday Camp Program Details <– Opens In New Window

Check all the programs you are applying for.

	Blast Off Into Rocketry Jan 3 \| 8:30am-3:30pm \| Gr. 4-6		Air Power Jan 7 \| 8:30am-3:30pm \| Gr. K-1

	Star Light, Star Bright Jan 4 \| 8:30am-3:30pm \| Gr. 2-3		Cosmic Capers Jan 21 \| 8:30am-3:30pm \| Gr. 4-6

Security Required

Security Code *

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Payment Information

1. We accept Check, Visa, Mastercard, Discover, Cash, or PayPal.
2. Student positions in programs are not guaranteed until payment has been received by CLCNM.
3. Payment for all missions is due 1 week before flight date.
4. Call (505) 248-1776 to make a payment by phone.
5. Mail or bring your payment to:	Challenger Learning Center New Mexico 1776 Montaño Road NW Los Ranchos de Albuquerque, NM 87107

CLICK THE SUBMIT FORM BUTTON BELOW TO COMPLETE YOUR REGISTRATION FORM

Registration Form

REGISTRATION FORM