EmailMe Form - JCC Camps at Medford Credit Card Form

Parent Name *
First Last
Legal name as on government issued identification.
Camper(s) Name: *
Billing Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Please enter the address that is on file with the card.
Email *

Confirm Email
Deposit Payment
Please provide payment details below for your deposit ($500/camper)
Credit Card

Card Number

All payment made by credit card are subject to a 3% service fee.

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Remaining Balance
Please choose from one of the following options to indicate your method of payment for your camper's tuition balance.
Remaining Balance Payment Option *
Authorization of Charges *
I do authorize
I authorize the Katz JCC to process payment based on the selections indicated on this form.