2023 NM District Kids Camp Registration

NM District Kids Camp 2023
Campfire Stories

July 12th-14th - $150 per Camper by June 15th, $170 after June 15th
for kids completing 2nd-6th grades

Bonita Park Campground
Ruidoso, New Mexico

Campers must be registered by June 15th to be guaranteed a Kids Camp T-shirt.

PAYMENT OPTIONS:
Individuals can pay Online using Tithely. At the end of this form you will be directed to Tithely to process payment. (Use this option even if you are coming with a church group, but prefer to pay for your child online. There will be a $5 online processing fee to use Tithely)

Churches may pay for a group of campers using a Business Check drawn on the Church Checking Account. The check must be mailed or brought to Kids Camp on July 12th.

NO PERSONAL CHECKS WILL BE ACCEPTED.

NOTE: ALL questions with * are required

Information About the Camper:

Camper's Name*

First NameLast Name

MaleFemale

Age*

Date of Birth: mm/dd/yyyy*

T-shirt Size - Choose One*

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

A NAZARENE Church in New Mexico or El Paso, TXOTHER ChurchNONE

Choose Camper's NM District NAZARENE Church from the Following List*

Please Enter Name and address of Camper's Church*

Information about Camper's Parent(s)/Guardian(s):

1st Parent Name*

First NameLast Name

1st Parent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

1st Parent E-mail*

1st Parent Preferred Contact Phone*

Area CodePhone Number

1st Parent Alternate Contact Phone

Area CodePhone Number

YesNo

2nd Parent Name

First NameLast Name

2nd Parent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

2nd Parent E-mail

2nd Parent Preferred Contact Phone

Area CodePhone Number

2nd Parent Alternate Contact Phone

Area CodePhone Number

YesNo

In Case of Emergency, Please Contact the Following
if Parents are not Able to be Reached:

Emergency Contact #1 Name*

First NameLast Name

Emergency Contact #1 Relationship to Child*

Emergency Contact #1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Emergency Contact #1 Phone Number*

Area CodePhone Number

Emergency Contact #1 Alternate Phone Number

Area CodePhone Number

YesNo

Emergency Contact #2 Name

First NameLast Name

Emergency Contact #2 Relationship to Child

Emergency Contact #2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Emergency Contact #2 Phone Number

Area CodePhone Number

Emergency Contact #2 Alternate Phone Number

Area CodePhone Number

Medical Information for the Camper

Medical Insurance Plan/Company*

Plan/Policy Number*

Plan/Company Phone Number*

Insured Party*

Relationship to Camper*

List ALL Allergies to food, medications, insect bites/stings, etc. (If none, enter NONE).*

Please describe any medical concerns such as asthma, diabetes, hay fever,etc. (If none, enter NONE).*

Please list all medications your Camper takes regularly. (If none, enter NONE).*

Please list all medications your camper will be bringing to camp. (If none, enter NONE).*

Sometimes minor health issues arise while at camp. Below is a list of over the counter medication we have on hand for minor health issues. Please select the medications you give permission for your child to receive while at camp.

ALL medications (prescription or OTC) must be turned into the Camp Nurse and be labeled in the original bottle/container.

By submitting this application you are giving permission for any of the group sponsors and staff of NM District Kids Camp to obtain medical attention in case of sickness or injury to the above named camper.

I do authorize the Leader or Sponsor of this activity, in the event I cannot be reached by phone, to give consent to a physician and/or hospital for emergency or surgical treatment for my child in the event of sickness or injury requiring emergency treatment while participating in this event. It is understood I will assume any financial responsibility for any expenses which may be incurred for said emergency treatment.

FURTHER, I do CERTIFY my child is covered by adequate medical insurance. My consent and signature is given below.

NOTE: A parent or guardian must download, sign and return to Bonita Park the INDEMNIFICATION AND RELEASE OF LIABILITY form. It will be emailed to you after you complete the registration and is also available to download at our website. You can also download it by clicking here.

Parent/Guardian Name*

First NameLast Name

Parent/Guardian E-mail*

Online Payment - Pay Now with Tithely ($155 by June 15, $175 after June 15)Check - To be Paid with Church Check ($150 by June 15, $170 after June 15)

NOTE: The Group Payment option is for Campers who are part of a church that will be paying for the entire group with one Business Check written on a Church Account...

Payable to:
NM District Church of the Nazarene

Memo line:
Kids Camp

Mailed to:
Christa Storch
1211 Carrizo St
Los Lunas, NM 87031

- OR -

Brought to Kids Camp on July 11th

Here is the QR-Code to make payment. Use your phone to scan the code and go to the web page to make payment. Please select the option to pay for the processing fee.

If you wish to print out a copy of this form, click the Print Form button before clicking the Register Now button.

To finish the Registration Process, click the Register Now button - if you have chosen the Thithely option, you will need to do that with your cell phone using the QR-Code (There is an additional $5 processing fee).

NM District Online Registration Form for Campers