This form must be completed and submitted no later than Thursday, April 16, 2026 to secure your spot at Energy Camp. Failure to submit the form by the deadline may result in forfeiting your selection. Energy Camp Winner Form Step 1 of 3 33% CommentsThis field is for validation purposes and should be left unchanged.Camper InformationCamper Name(Required) First Last Camper Gender(Required) Male Female Camper Birthdate(Required) MM slash DD slash YYYY Camper School(Required)Camper Home Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Camper T-shirt Size (runs small)(Required) Small Medium Large X-Large 2X-Large 3X-Large Parent InformationParent/Guardian #1 Name(Required) First Last Parent/Guardian #1 Email(Required) Parent/Guardian #1 Phone Number(Required)Parent/Guardian #2 Name First Last Parent/Guardian #2 Email Parent/Guardian #2 Phone Number Upload Camper Photo(Required)Max. file size: 256 MB. Please upload a clear, high-quality headshot of yourself. This photo will be used to announce you as an Energy Camp winner in PEC publications, on our website, and on social media. 📸 Photo Guidelines: ✔ Use a recent, well-lit photo of yourself ✔ Face the camera with a neutral or smiling expression ✔ Avoid hats, sunglasses, or heavy filters ✔ Use a plain or uncluttered background ✔ Ensure the image is high resolution (not blurry or pixelated)Photo Release Agreement(Required) By checking this box, I confirm that I am the parent or legal guardian of the participant and agree to the terms of this photo release.As the parent or legal guardian of the participant, I hereby authorize People’s Electric Cooperative to use my child’s image for any and all advertising, publicity or illustration purposes including reproduction in print, web and/or broadcast media (including social media) without limitations. Neither my child nor I will receive any compensation from People’s Electric Cooperative for this now or at any time in the future. I further certify that I am 18 years of age or older.Parent/Legal Guardian Name Signing for the Photo Release Agreement(Required) First Last Date(Required) MM slash DD slash YYYY Camper Bio(Required)Please provide a short bio about yourself. This will be used to introduce you as a PEC Energy Camp winner in announcements and publications. Your bio should be 3-5 sentences and include details like your name, school, hobbies, interests, and any leadership roles or accomplishments you’d like to share. 📌 Example: “Hi, my name is Jordan Smith, and I’m an 8th grader at Oakwood Middle School. I enjoy playing basketball, participating in my school’s student council, and volunteering at the local animal shelter. In my free time, I love reading mystery novels and spending time outdoors. I’m excited to attend Energy Camp and learn more about leadership and electric cooperatives!”
