Electrify 2022 Interest Form

Electrify 2022 Interest Form

Please fill out this form if you are interested in participating in Electrify Tech Camp 2022. We expect to have an update regarding the status of the camp January 2022.

* Required

Student First Name *

Your answer

Student Last Name *

Your answer

Guardian First Name *

Your answer

Guardian Last Name *

Your answer

Guardian Email *

Your answer

Student's grade level 2021-2022 *

Freshman

Sophomore

Junior

Senior

Has your student attend Electrify Tech Camp before? *

yes

no

Preferred Contact Number *

Your answer

Student's School *

Your answer

Student's School City *

Your answer

Student's School State *

Your answer

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