CAMP SCATICO

     2018 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
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.