Energy Summer Institute Registration

Register now for the 2013 Energy Summer Institute. Please be prepared to answer the following questions and have your parents' or guardians' permission to register.

Student Information

• Name
• Mailing Address
• Home Phone Number
• Cell Phone Number
• E-Mail Address
• Age
• Gender
• Ethnic Background (voluntary)
• School currently attending
• Grade currently enrolled in
• Briefly describe your participation in activities, both in and out of school
• Explain why you want to participate in the Energy Summer Institute and what you hope to gain from the experience

Parent/Guardian Information

• Parent/Guardian Names
• Mailing Address
• Daytime Phone Number
• Evening Phone Number
• Cell Phone Number
• Parent/Guardian E-Mail Address

Camp Information

• T-shirt size (adult men's)
• Dietary requirements
• Food allergies or special meal considerations
• Do you have a physical, sensory, cognitive or psychological disability and require accommodations?
• Any other needs?
• How did you learn about the Energy Summer Institute program?