EmailMe Form - JCC Camps at Medford EFT 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

Please provide payment details below for your deposit ($500/camper)

Name of Bank:

Type of Account: *

Checking

Savings

Routing Number *

Account Number *

Payment Options: *

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.