Energy Camp Application

Name

This field is for validation purposes and should be left unchanged.

Student Name(Required)

First Last

Student Email (accessible in the summer)(Required)

Student Phone

Student Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Student Middle School

Parent/Guardian #1 Name

First Last

Parent/Guardian #1 Email

Parent/Guardian #1 Phone

Parent/Guardian #2 Name

First Last

Parent/Guardian #2 Email

Parent/Guardian #2 Phone

Student T-Shirt Size

Student Date of Birth (MM/DD/YYYY)

Student's Principal Name

First Last

Student's Principal Email

How did you hear about the opportunity to attend Energy Camp?

What makes you a good candidate to represent Kay Electric at Energy Camp? What do you hope to learn at Energy Camp?

Commitment to Community is one of the seven core cooperative principles. What activities are you involved in at school and within your community?

What leadership skills have you learned by being involved in these activities?

Who or what inspires you to be a leader?

How would your life change if you did not have electricity?

Please provide 1 reference (that you have permission from) for us to contact on your behalf. Please provide a reference outside of your English teacher.

Name

First Last

Phone

Signature (Full Name)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent or Guardian Signature (Full Name)

Energy Camp Application

Keep In Touch

Main Office

Mailing Address

Office Hours

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