[ ] Two Week Session June 19 - Julne 29
[ ] One Week Session June 19 - 23
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
83 Cousins Corner Ln
Rochelle VA 22738