Name of Camper __________________________________________________________ Today's Date ____________

Address ____________________________________________ City __________________ State _____ Zip _________

Birth ______________Age (camp time) _____ Entering Grade _______ At ______________________________ School

Parent or Guardian ________________________________________________________________________________

Phone (home) _____________________________________ Cell ___________________________________________

E-mail ___________________________________________________________________________________________

Please include a $20.00 registration fee. Make checks payable to ARC Natural History Day Camp.​

Return this form to:

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ARC Natural History Day Camp
1870 Amberfield Dr

Charlottesville VA 22911