Challenger Learning Center Summer Space Camp Registration Form 1st-2nd Grade
Registration
This registration form must be completed and all payments made no later than May 19, 2017. Camps are limited in size; therefore, registration applications will be processed on a first come, first served basis. Registration is complete and confirmed on receipt of $50 down payment for four-day summer camps and/or full payment for single days and field trips. Payment must be made in person at the LCPS Challenger Learning Center/PDC located at 505 S. Main St. Ste. 400 Monday - Friday from 8:00 am - 1:00 pm or 2:00 pm - 4:45 pm. Registration process and full payment must be complete by the first day of the camp. Only cash and check will be accepted (no credit card/debit payments).

Camp Administration
Camps will be conducted at the Challenger Learning Center of Las Cruces located at the LCPS Professional Development Center 505 S. Main St. Ste. 400. Parents/guardians must designate on this registration form an authorized individual to drop off/pick up campers if parents/guardians are unable to do so. Parents/guardians and/or authorized individuals must accompany campers into the building and sign them in and out every day. Parents/guardians must always have photo ID with them and be listed as an authorized individual.

Conduct
Camps are designed for the enjoyment and benefit of all campers enrolled. Our goal is to provide a strong academic experience for students as they learn and have fun. All student participants are expected to abide by camp rules: Be Respectful, Be Responsible, Be Ready. Should any disciplinary problems occur, we will contact the parent/guardian to pick up their camper. Please do not send any toys, books, electronic devices, etc. with the camper.

Cancellations/Refunds
Requests for cancellation must be received in writing by the Challenger Learning Center prior to camp session start date. Full refunds will be allowed for written requests received two weeks in advance of the camp's start date. Half refunds will be allowed for written requests received one week in advance of the camp's start date. No refunds will be granted after the camp session start date. Please allow approximately 60 days for refunds to be processed.

Contact Information
Should you need additional information, please call Lisa Fernandez (Challenger Learning Center Secretary) at 575-527-9300.

Camper Information
Last Name *
Your answer
First Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
What school will the student attend for the 2017-2018 school year? *
Your answer
What grade will the student be enrolled in for the 2017-2018 school year? *
Lunch *
Please select which lunch option the camper will utilize.
T-Shirt Size *
What are your child's learning strengths and areas of academic interest? *
Your answer
Parent/Guardian Information
Last Name *
Your answer
First Name *
Your answer
E-Mail Address *
Your answer
Cell Phone Number *
Your answer
Work Number
Your answer
Home Number
Your answer
Emergency Contact Information *
Name and phone number of a secondary contact in case of emergency.
Your answer
Summer Academy Selection
Camp hours are 9:00 am - 3:00 pm. Campers are not registered until the deposit is made. If selected camp is full, your child would be placed on the waiting list. Individual days will be $45.00 per date or your child can participate in all four days for $165.00. Please select all dates that will be attended. Remaining balance for four-day summer camps are due in full by May 19, 2017.
Which Micro Explorer Academy(s) will your child attend? *
Required
Will you child need extended hours for Space Academy? *
Required
Which Field Trip(s) will your child attend? *
Required
Pick Up Authorization
Please note all parents/guardians and authorized individuals must present photo identification when picking up your camper.
People authorized to drop off and/or pick up my child from the Challenger Learning Center Space Camp are: *
Please include first and last name of all parents/guaridans, family and/or friends that may drop off or pick up your child.
Your answer
Medical History and Consent Form
Please list any facts concerning the child's medical history, any physical impairments or conditions, and medications currently taken to which the camp staff should be informed. *
Examples- asthma, food allergies, diabetes, etc.
Your answer
Electronic Signature *
Indicates you have read the above policies and expectations for the Challenger Learning Center Summer Space Camp.
Your answer
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