NM CHILD CARE ASSISTANCE REGISTRATION FORM

NM CHILD CARE ASSISTANCE ENROLLMENT & REGISTRATION FORM

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Be Elite Summer Academy Registration Form for Family's Participating in the New Mexico Child Care Assistance Program

All required fields are indicated with an *

Please Read: Important Information for New Mexico Child Care Assistance Program Participants

After you submit our registration form, you will be directed to our secure payment link. If you plan on using your New Mexico Child Care Assistance to pay for your registration, you can exit out of the payment window when you are directed there. Your registration form will then be submitted, and you will get a confirmation email with info regarding your child care assistance.

Is your family participating in the New Mexico Child Care Assistance Program?

If yes, case number (if known):

Parent or Guardian 1 *

First

Last

Relationship to Participant *

Contact Information

Email Address *

Cell Phone *

Address Information

Home Address *

Street

Home Address

Unit/Apt

Home Address *

City

Home Address *

State

Home Address *

Zip Code

Employer

Work Phone

Parent or Guardian 2

First

Last

Relationship to Participant

Email Address

Cell Phone

Home Address

Street

Home Address

Unit/Apt

Home Address

City

Home Address

State

Home Address

Zip Code

Employer

Work Phone

Emergency Contacts

Please list emergency contact name and phone number

Emergency Contact Information (Other than parents) *

First

Last

Relationship to Participant *

Phone Number *

Optional Emergency Contact Information 2 (other than parents)

First

Last

Relationship

Phone Number

Authorized Pickup Persons (Individual allowed to pick up participant)

Photo ID may be required at pick up

Name *

First

Last

Phone Number *

Name *

First

Last

Phone Number *

Name *

First

Last

Phone Number *

Participants Information

Upload Profile Picture

Click or drag a file to this area to upload.

Academy Participant

Academy Participant Information *

First

Last

Gender *

Participants Age *

Date of Birth *

Street *

City *

State *

Zip *

Medical Information

Policy Number *

Input NA if not known and we can get this info at a later date

Primary Physician *

Input NA if not applicable

Physician Phone Number

Health Insurance Provider *

Input NA if not known and we can get this info at a later date

Allergies (food, medication, environmental) *

Input NA if not applicable

Medical Conditions *

Input NA if not applicable

Medication Taken *

Input NA if not applicable

Emergency Medical Authorization

I authorize program staff to seek emergency medical treatment for my child if I can not be reached.

Parent / Guardian Name *

I hereby agree to the Emergency Medical Authorization

Date *

T-Shirt Size (copy) *

Participants School Grade *

Grade Participant will be in Entering the 2026-2027 School Year

School Attending

School attending for the 2026/2027 school year

How did you here about us *

Behavioral Policy

Please read and review our camper rules of conduct and discipline policy.

Code of Conduct The foundation of our program is respect; respect for the truth, respect for learning, and respect for the place in which one learns. We expect campers to always understand and uphold the essential values of honesty and respect. Campers should always act in accordance with these guiding values. Therefore: Honesty is expected at all times. Stealing and/or destruction of property is never permissible. The possession, distribution, or use of alcohol or other chemical substances on campus is never permissible. Harassment of others and foul language will not be tolerated. Campers should also understand that there are rules which are necessary for the safety of every member of our community. They must understand, accept, and observe these rules. Campers are expected to behave in accordance with the principles of good taste and decorum and comply with all rules and regulations set forth by the camp. All participants must be toilet trained and able to use restroom without assistance. Parents should also be familiar with camp procedures, rules and policies and lend their support when requested. Self-discipline is a distinguishing characteristic of the campers at the Be Elite Summer Academy. Self-discipline and the ability to distinguish right from wrong are challenges that each camper will meet during her/his lifetime, The Be Elite Summer Academy does not tolerate behavior that is disruptive, destructive, immoral, or illegal. Should a disciplinary problem arise, parents/guardians will be contacted. Continued disciplinary problems may result from permanent removal from summer camp (No refunds will be given). I hereby agree to the content of the behavioral policy: *

I hereby agree to the content of the behavioral policy

Be Elite Summer Academy Release & Waiver of Liability

Please read and review our release & waiver of liability policy.

In consideration of my minor child being given the opportunity to participate in any activities of the Be Elite Summer Academy, I for myself and my child and our respective heirs, assigns and next of kin: Acknowledge, agree and represent that I understand the nature and all possible risks and dangers of the Be Elite Summer Academy activities, and that mu child is capable, qualified, in good health, and proper physical condition to participate In such activities other than as listed below. Understand that I/we fully accept and assume all risks and all responsibility for losses, costs, and damages of every kind and nature incurred as a result of my child’s participation in Summer Academy activities. I hereby release, discharge, covenant not to sue, and agree to indemnify, save, and hold harmless the Be Elite Summer Academy, its employees, Trustees, agents, contractors, volunteers, and service or facilities providers collectively the “releases”) from all liability, claims, demands, losses, or damages on the minor’s account caused or alleged to be caused in whole or part by the negligence of the releases, or otherwise. Furthermore, if, despite this release, I, the minor participant, or anyone on the minor’s behalf makes a claim against any releases, I will indemnify GATA Athletics Inc, Be Elite Athlete, The Be Elite Summer Academy from any litigation expenses, attorney fees, loss liability, damage, or cost that may incur as the result of any such claim. The company reserves the right to use any photos taken during our camps for promotional purposes. If you do not want your child’s photograph to be used for these purposes, please contact beeliteathlete@gmail.com. I hereby agree to the content of the waiver as stated: *

I hereby agree to the content of the waiver as stated above:

I have read this release and waiver, and I fully understand its terms and the rights being waived by its execution. *

I Agree

Date *