Mescalero Apaches | Ruidoso, NM

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Name

Age

Date of Birth

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Phone

Address

Best way to contact you

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Email Text Call

Married

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Yes No

If yes, will your spouse be joining the trip

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Yes No

Spouse's Name

Will your children be joining?

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Yes No

If yes, please list the childrens name and ages

Are you a born again Christian/Baptized?

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Yes No

If yes, how long?

Can you swim really well?

Service Positions

Please select all that you may be interested in.

Please select all that apply.

Children's Teacher Adult Teacher Food/Cook Crafts Swim Chaperone Prayer Team Bus Driver Puppets Games

Minor Release

Children 16 and older may attend the trip with parental or guardian consent.

Do you give permission for your child to go on this mission trip

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Yes No

Parent's Signature (Full Name)

Date

Payment

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If paying for multiple participants use the 'OTHER' option and type in the total amount.
If you have payed with your family or spouse on a separate form. Please make a note with the Name of the form where the payment was done. Thank you

Payment

Adult ($200) Child ($50) Other Payment done on another form ($0)

Amount

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Credit/Debit Card Number

Expiration Date/CVC

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Description

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Mescalero Apaches | Ruidoso, NM

Description

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