[   ] Two Week Session June 15 - 25

[   ] One Week Session June 15 - 19

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:

ARC Natural History Day Camp
1870 Amberfield Dr

Charlottesville VA 22911