APPLY TO ATTEND CYBERCAVE ACADEMY
(Please complete all fields)

Please Select Your First Choice for Camp:

Please Select Your Second Choice for Camp:
(If this is your second year, you can leave this blank.)

Male Female

Birthdate:

First Name:

Last Name:

Address:

City:

State:

Zip Code:

Email:

Phone Number:

Spring Grade Level:

GPA:

High School:

Adult T-Shirt Size:
S M L XL XXL Other

Do you plan to bring a personal computer to use during free time?
Yes No
Will you need internet access?
Yes No

Parent/Guardian Info (Optional if child is over 18)

Parent/Guardian Name:
Parent/Guardian Email:
Parent/Guardian Phone:
In 100 words or less explain why you should be selected to attend one of the CyberCave Academy summer camps. There is no correct answer; this is an opportunity to let us know your interest in technology and get to know you a little bit better.