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[   ] Two Week Session June 19 - June 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

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