[   ] Two Week Waiting List June 17 - 27

[   ] One Week Waiting List June 17 - 21

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
1780 Easy Lane

Charlottesville VA 22911