CAMP SCATICO

     2019 Camper Enrollment Form FOR the 1-wEEK PROGRAM

Camper's Name *
Camper's Name
Date of Birth *
Date of Birth
Another Home Address
Emergency Contact Information in Addition to Parent(s)/Guardian(s)
Payment Options (Please select ONLY one)
1) Pay By Mail
2) Pay By Electronic Check.
3) Pay By Credit Card.
Signature
Payment Method Confirmation *
Provided Information *

Please note: If you selected Payment Option 3 (Pay by Credit Card) after submitting the Registration Form continue to "Pay By Credit Card Now" button below.