2019
RESIDENT
camp registration
Complete ONE form for each individual camper. You may register for more than one camp session on this form, but only for one camper. A minimum deposit of $100* is due with registration per camp session. A $40 membership fee is also due if you not a currently registered Girl Scout. This registration form must be completed in full to be accepted. Submit completed forms with payment to: Mail: GSNMT, 4000 Jefferson Plaza NE, Albuquerque, NM 87109 Fax: 505-343-1050 CONTACT INFORMATION Email: customercare@nmgirlscouts.org Camper Full Legal Name: ____________________________________________________ Grade in Fall 2019: __________ Age at time of camp: ________ Is camper a registered Girl Scout? (circle one) yes / no (if camper is not registered Girl Scout, pay membership fee below) Parent/Guardian Name: _____________________________________________________________________________________ Address: __________________________________________________ City/State/Zip: __________________________________ Phone: ___________________________ Email: __________________________________________________________________
CAMP SELECTIONS
Coming to camp with a buddy who you would like to bunk with? Let us know her name: ______________________________ Camper buddies must be attending the same program and dates. List no more than 2 camper buddies. How will camper get to & from camp?
Which camp? (check one)
Program Name
� Barker
Dates
Fee
Bus or Car, select TO and FROM camp
Bus pick-up & drop-off location Rancho Barker
� Rancho
Car � TO Bus � TO
� FROM � FROM
� Abq � Cuba
� Abq � Santa Fe � Espanola
� Rancho
Car � TO Bus � TO
� FROM � FROM
� Abq � Cuba
� Abq � Santa Fe � Espanola
� Rancho
Car � TO Bus � TO
� FROM � FROM
� Abq � Cuba
� Abq � Santa Fe � Espanola
� Day � Resident
� Barker � Day � Resident
� Barker
check transportation preference; if riding bus, select location
� Day � Resident
Does camper have special dietary, medical, health, or other needs that we should be aware of before camper arrives at camp? If so, please explain here OR contact the camp registrar at customercare@nmgirlscouts.org at least 3 weeks prior to the camp session ____________________________________________________________________________________________________
PAYMENT INFORMATION
Attending MACH I? We must have your camper’s shoe and pant size for program equipment: Shoe size: _____ Pant size: _____ FEE DESCRIPTION
FEE
Payment Information
Session Cost(s)
+$
Bus transportation TO camp ($10)
+$
Bus transportation FROM camp ($10)
+$
Membership registration fee (if applicable) ($40)
+$
Contribution to Camperships (optional)
+$
TOTAL FEES Credits/ Vouchers
$ 2018 Program Vouchers (must be used by 4/30)
-$
2019 Program Vouchers (available for use after 5/1)
-$
Sibling Discount, $5 (Name of sibling _________________)
-$
Multi-Session Discount ($25 per session, after first)
-$
TOTAL PAYMENT DUE
TOTAL PAYMENT DUE.
$ (Must be at least the minimum deposit)
$
Payment Method: � Cash � Check � Credit Card Credit Card #:
Exp. Date:
Name on Card:
Zip Code:
Signature:
CVV #:
Payment is due in full three weeks prior to start of session. Program Vouchers: Vouchers must be present to be redeemed. Mail or bring in voucher(s) to La Tienda with registration form. Any registrations made after 5/31/19 for any session must be paid in full at time of registration. *Deposits: minimum of $100 for EACH resident camp program is due at time of registration. If applying for a campership, a $50 deposit is due at time of registration. Payment of deposit does not guarantee a spot in desired session; sessions must be paid in full to guarantee spots.