[ ] Jr. Session June 9 - 13
[ ] Regular. Session June 9 - 20
A.R.C. Natural History Day Camp
Name of Camper ______________________________________________ Today's Date ________________

Address ____________________________________ City __________________ State _____ Zip _________

Birth ________________ Age (camp time) _____ Entering Grade ____ At ______________________ School

Parent or Guardian _________________________________________________________________________

Phone (home) ________________________ Work/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
8594 Faber Rd
Faber VA 22938