ADULT RESPONSIBLE FOR PAYMENT
First Name _________________________________ Last Name __________________________________ E-mail __________________________________ Day Phone (____) ___________________________ Evening Phone (____) __________________________ Cell Phone (____) ________________________ Street Address ____________________________________________________ City_____________________State_______Zip ______________________
CHILD BEING REGISTERED
First Name ______________________________________________________ Last Name ___________________________________________________ month day year Grade ___________Birthday______/______/______Sex ____________________ School ______________________________________________________
Please fill in camp codes below. Insert the five-digit code associated with the Arlington County camp into the first or second choice for each session you desire. The sixth digit is prefilled to represent the session week, while the C or E designates registration for Core Program Hours or Extended Hours. Children must be registered for the core program hours to register for extended hours. Not all camps provide Extended Hours. You will need these same seven-digit codes to register online. If you wish to register for a camp that does not have a 5-digit camp code, please follow the registration instructions contained in the camp listing.
First Choice
SESSION CAMP NAME CAMP CODE CORE CAMP SESSION CAMP NAME
Second Choice
CAMP CODE CORE CAMP
1
1 C ___ ___ ___ ___ ___ ___ ___
1
1 C ___ ___ ___ ___ ___ ___ ___
1
2
1 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
1
2
1 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
2 C ___ ___ ___ ___ ___ ___ ___
2 C ___ ___ ___ ___ ___ ___ ___
2
3
2 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
2
3
2 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
3 C ___ ___ ___ ___ ___ ___ ___
3 C ___ ___ ___ ___ ___ ___ ___
3
4
3 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
3
4
3 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
4 C ___ ___ ___ ___ ___ ___ ___
4 C ___ ___ ___ ___ ___ ___ ___
4
5
4 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
4
5
4 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
5 C ___ ___ ___ ___ ___ ___ ___
5 C ___ ___ ___ ___ ___ ___ ___
5
6
5 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
5
6
5 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
6 C ___ ___ ___ ___ ___ ___ ___
6 C ___ ___ ___ ___ ___ ___ ___
6
7
6 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
6
7
6 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
7 C ___ ___ ___ ___ ___ ___ ___
7 C ___ ___ ___ ___ ___ ___ ___
7
8
7 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
7
8
7 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
8 C ___ ___ ___ ___ ___ ___ ___
8 C ___ ___ ___ ___ ___ ___ ___
8
9
8 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
8
9
8 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
9 C ___ ___ ___ ___ ___ ___ ___
9 C ___ ___ ___ ___ ___ ___ ___
9
10
9 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
9
10
9 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
CORE CAMP
0 C ___ ___ ___ ___ ___ ___ ___
0 C ___ ___ ___ ___ ___ ___ ___
10
0 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
10
0 E EXTENDED DAY ___ ___ ___ ___ ___ ___ ___
ALL REGISTRANTS MUST SIGN
I have read, understand and agree to the payment, refund and changes in registration policies on page 26 of this brochure.
Signature _____________________________________________________________Date __________________
To support the “SUMMER FUN” (see page 4) indicate amount of donation here $ ________________________________ To pay by check: Make check payable to: Treasurer, Arlington County. At least 50% is due with registration. To pay 50% at time of registration check the box. Remainder is due June 9, 2008. To Pay by Credit Card: Please fill out information below. Please charge my: VISA MasterCard Discover American Express Card Number _________________________________________Expiration Date ______________________________________________________ Name of cardholder (please print): _______________________________ Signature ______________________________________________________ Mail materials by March 3 or drop off beginning March 24 at: PRCR Registration Office, 300 North Park Drive #204, Arlington, VA 22203
Camp Catalogue Summer 2008 29