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Camp Susquehannock 2019 Registration
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Multi-Sport Athletic Development & Confidence Based Learning for Children Between the Ages of Seven & Sixteen
Full Name of Camper (Last, First)
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Nickname
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Date of Birth (MM/DD/YYYY)
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School Attending
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Grade Completed by July 1, 2019
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Home Address
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Parent/Guardian Preferred Phone
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Parent/Guardian Email
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Camper Email
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Do you have any friends who might be interested in Camp Susquehannock? (Please include contact information)
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Session Interest (Check all that apply)
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Full Season: Sat. June 29 - Sat. August 11 (50 days)
First Session: Sat. June 29 - Mon. July 22 (24 days)
Second Session: Thu. July 25 - Sat. August 11 (24 days)
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Payment
If using credit card to pay deposit of $1,000, please complete the following sections
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Card Number
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Expiration Date
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CVC Code
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Authorized Electronic Signature
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Cardholder's Name
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Billing Address on Card
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