Camp Susquehannock 2019 Registration
Sign up before September 1 to receive 2018 rates!
Email address *
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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*
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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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Payment
If using credit card to pay deposit of $1,000, please complete the following sections
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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