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Sun: Noon-5pm

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757-595-1900

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Virginia Living Museum
6th and 7th Grade
Summer Registration Form

For students who have completed 6th or 7th grade. 

The cost of the camp is $390 for members and $450 for non-members.

 


Please submit a separate form for each applicant.


If indicated, some classes or dates may be currently sold out. If you would like to be added to the waiting list for a sold out date, please contact Reservations at 757-595-9135.

I am a VLM Member
Members Only: Select from the following sessions.
Non-Members, continue to next section of form.


Week-Long Program: Mountain Explorers (July 9-13)
I am NOT a member of the VLM
Non-Members Only: Select from the sessions below.
Members: Select from above options.


Week-Long Program: Mountain Explorers (July 9-13)
  
Applicant's Name:  
Name I Go By:  
Date of Birth (xx/xx/xxxx):  
Gender:  
Grade Completed (as of summer 2012):
Name & City of Applicant's School:  
Is the Applicant able to swim?  

This Field School involves high levels of physical exercise and concentration.
Does the applicant have any medical or health conditions we should be aware of?
Any medical conditions?  
If yes, explain:
What nature interests does the applicant have?  
Has the applicant camped overnight before?  
  
Parent or Guardian's Name:  
Address:  
City:  
State:  
Zip:  
Home Phone:  
Work Phone:
Email:  
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