CAMP SCATICO

     2019 Camper Enrollment Form

Camper's Name *
Camper's Name
Date of Birth *
Date of Birth
Camper's Name - Sibling 1
Camper's Name - Sibling 1
Date of Birth - Sibling 1
Date of Birth - Sibling 1
Camper's Name - Sibling 2
Camper's Name - Sibling 2
Date of Birth - Sibling 2
Date of Birth - Sibling 2
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. Please choose one of the following two options.
3) Pay By Credit Card. Please choose one of the following two options.
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.