Registration Form

REGISTRATION FORM

Summer Camp Program Details <– Opens In New Window

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 | Summer Camp Program Details <– Opens In New Window

Check all the programs you are applying for.
Note: campers staying for two camps (one morning and one afternoon) need to bring their lunch. There will be adult supervision, but lunch is not provided.

	Robotics June 11-15 \| 9:00am-Noon \| Gr. 4-8		Up In The Air July 9-13 \| 9:00am-Noon \| Gr. 4-6

	Crater Kids 1 June 11-15 \| 9:00am-Noon \| Gr. K-1		Mission To Mars July 9-13 \| 12:30pm-3:30pm \| Gr. 2-3

	Rocketry June 11-15 \| 12:30pm-3:30pm \| Gr. 4-8		Crater Kids 2 July 23-27 \| 9:00am-Noon \| Gr. K-1

	Space Girls 1 June 11-15 \| 12:30pm-3:30pm \| Gr. 1-3		Paper Capers July 23-27 \| 9:00am-Noon \| Gr. 3-6

	Cosmic Capers June 25-29 \| 9:00am-Noon \| Gr. 4-6		Space Crafters July 23-27 \| 12:30pm-3:30pm \| Gr. 3-6

	Tiger Team June 25-29 \| 9:00am-Noon \| Gr. 6-8		Racing To Space August 6-10 \| 9:00am-Noon \| Gr. 2-4

	Space Girls 2 June 25-29 \| 12:30pm-3:30pm \| Gr. 4-6		Micronauts August 6-10 \| 12:30pm-3:30pm \| Gr. 2-4

	Flight Specialists July 9-13 \| 9:00am-Noon \| Gr. 1-3

Security Required

Security Code *

Enter Security Code

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