Summer Camp Payment Agreement FormSummer Camp Payment Agreement • February 28th, 2022
Contract Type FiledFebruary 28th, 2022Today's Date Staff Assisting Personal Information Person responsible for payments Relationship to Camper Camper's Name(s) 1.2.3. 4.5.6. Billing Information First Name Last Name Date of Birth Home Address City State Zip Home Phone Primary Email Work/Cell Phone Bank Information Bank Account Details(attach voided check)Name on Account: Account Type: CheckingSavingsRouting Number: Account Number: Credit Card Details(attach copy of credit card)Name on Account: Card Type: MasterCard VisaAmerican Exp. DiscoverAccount Number:Expiration Date: CVV #: Please use my account on file ending in (list the last 3-4 digits) Payment Schedule Information (choose one) Weekly Draft Weekly Cash or Check Payments Session Draft Date Amount Due Session Payment Due Amount Due May 31-June 3 (30th Holiday) 5/27/2022 May 31-June 3 (30th Holiday) 5/27/2022 June 6 -10 6/3/2022 June 6 -10 6/3/2022 June 13-17 6/10/2022 June 13-17 6/10/2022 June 20-24 6/17/2022 June 20-24 6/17/2022 June 27-Jul