Camp Susquehannock 2019 Registration
Sign up before September 1 to receive 2018 rates!
Email *
Multi-Sport Athletic Development & Confidence Based Learning for Children Between the Ages of Seven & Sixteen
Full Name of Camper (Last, First) *
Nickname
*
Required
Date of Birth (MM/DD/YYYY) *
School Attending *
Grade Completed by July 1, 2019 *
Home Address *
Parent/Guardian Preferred Phone *
Parent/Guardian Email
Camper Email
Do you have any friends who might be interested in Camp Susquehannock? (Please include contact information) *
Session Interest (Check all that apply) *
Required
Payment
If using credit card to pay deposit of $1,000, please complete the following sections
Clear selection
Card Number
Expiration Date
CVC Code
Authorized Electronic Signature
Cardholder's Name
Billing Address on Card
Submit
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