Energy Camp Detailed Registration Form

Energy Camp Registration
Rising 8th graders!(current 7th graders)

A fun and interactive leadership camp where students build lasting friendships while diving into the core values and operations of electric cooperatives.

Campers will grow their confidence and communication skills while discovering the power of working together.
- Teamwork & Leadership Fundamentls
- Positive Peer Interactions
- Electric Safety Basics
- Self-Awareness & Stress Management
- Confidence in Small Groups
- Cooperative Systems & Operations
- Respect & Responsibility
- Public Speaking & Presentation Skills
All expenses are covered by Kiamichi Electric Cooperative, including round-trip transportation!

Student interested in attending must submit a short essay, no more than 250 words, about one of the Seven Cooperative Principles. Students will attach the essay to this entry form.

Deadline is March 27th.
Camper Name*

First NameLast Name
Camper Information
MaleFemale
Birth Date*

MonthDayYear
Camper School*
Camper Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
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Parent/Guardian Information
Name*

First NameLast Name
E-mail*
example@example.com
Cell Number*
Format: (000) 000-0000.
Home Number
Format: (000) 000-0000.
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Format: (000) 000-0000.
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Upload essay here.*

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Date*

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Date
Signature*

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Energy Camp Registration

Camper Information