Energy Camp Entry Form

Student Name

Student Email (accessible in summer)

Student Phone

Student Mailing Address

City/Town

State/Province

ZIP/Postal Code

Student Middle School

Parent/Guardian #1 Name

Parent/Guardian #1 Email

Parent/Guardian #1 Phone

Parent/Guardian #2 Name

Parent/Guardian #2 Email

Parent/Guardian #2 Phone

Student T-Shirt Size

Student Date of Birth

Student’s Principal Name

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

Name

Email

Phone

Energy Camp Media Release Form

I understand that through my participation in the Kay Electric Cooperative Youth competition, my name, image and information provided by me to the cooperative may be used in various forms of media (print, video, web, etc.).

I hereby consent and authorize the use of my image and information by Kay Electric Cooperative and anyone authorized by Kay Electric Cooperative.

I agree to the terms of service.

I understand that through my participation in the Kay Electric Cooperative Youth competition, my name, image and information provided by me to the cooperative may be used in various forms of media (print, video, web, etc.).

I hereby consent and authorize the use of my image and information by Kay Electric Cooperative and anyone authorized by Kay Electric Cooperative.

Signature

Sign above

Printed Name

Address

City/Town

State/Province

ZIP/Postal Code

Parent or Guardian Name

Signature of parent or guardian

Sign above

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Energy Camp Entry Form

Contact Info

Phone & Email

Weather Forecast