EventsPlease fill out separate applications for patient and siblings. Step 1 of 5 20% Participant's Name* First Middle Last Date of Birth* MM DD YYYY Age*Patient or SiblingPatientSiblingShirt Size*Small AdultMedium AdultLarge AdultX Large Adult Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email Mother/Guardian Name* First Last PhoneFather/Guardian's Name First Last Emergency Contact* First Last Emergency Contact's Phone* Special Needs?Does your child have any food allergies?Is your child taking any medications? If yes please explain any we should be aware of..Does your child have any emotional and/or physical limitations that would hinder him/her from participating in any activities? If so, explain. * Agree Disagree I, parent or legal guardian gives consent for my child to be photographed, filmed, and/or interviewed and hereby give permission that these photographs, films, and other information may be used for various materials for CCFNM such as newsletters, brochures, flyers, videos, website, Facebook and other materials that may be created or implemented at future dates. * Agree Disagree I, parent or legal guardian fully understand that for my child's safety and the safety of others, my child must follow all rules of the Central New Mexico Community College and those of Children's Cancer Fund of New Mexico chaperones. * Agree Disagree I, parent or legal guardian understand that disrespectful or disruptive behavior (including but not limited to name calling, use of offensive language, and any behavior that could result in harm physical and/or emotional to others) will not be tolerated. First infraction will result in a verbal warning. Second infraction, CCFNM will notify parents/guardian and ask that their child be picked up immediately. * Agree Disagree I, parent or legal guardian of the applicant asks for permission for my child to attend the College Day at the Central New Mexico Community College. I will not bring any action whatsoever upon any grounds against the Central New Mexico Community College and/or Children's Cancer Fund of New Mexico, their agents or servants for any wrongful death, injury (physical or emotional), or property damage that may occur as a result of attending the College Day Event. I fully hold the CNM and Children's Cancer Fund of New Mexico and their agents and servants harmless from any such death, injury, or property damage. Digital Signature (Please type name)*I have read, agree, and provided accurate information for my child. This iframe contains the logic required to handle AJAX powered Gravity Forms. CCFNM Cookbook Step 1 of 4 25% What you'll need for submission: HANDWRITTEN copy of recipe Photo of child-- preferably cooking Cookbook name suggestion Art of Cookbook Cover Child's Name First Last Parent / Guardian Email Parent / Guardian Phone Recipe CategoryAppetizerSoupSaladVegetable or Side DishMain DishBaked GoodDessertBeveragePhoto of Child - Preferably Of Them Cooking* Drop files here or Accepted file types: jpg, gif, png, pdf, doc, docx. Recipe: Handwritten for child submission, please.* Drop files here or Accepted file types: jpg, gif, png, pdf, doc, docx. WIN A PRIZE!Name of Cookbook Suggestion- CCF Children OnlySuggestions will be made by CCFNM kids. A panel of board members and staff will make the selection and the child whose submission is deemed best will receive a $50 Gift Card. Design the Cookbook Cover- CCF Children Only Drop files here or Accepted file types: jpg, gif, png, pdf, doc, docx. Children are encouraged to submit a drawing to be used on the cover of the cookbook. The child whose submission is selected will receive a $50 gift card. All other drawings will be included within the cookbook. This iframe contains the logic required to handle AJAX powered Gravity Forms. Learn how you can get involved today.Make A DonationContact Us