Personal Information

Names

• Your First name:

• Your Last name:

• Parents/Guardians:

• Current School:

Home Address

• Street:

• City:

• Zip Code:

Phone Numbers

• Example Format:
• 208-111-1111

• Home/Main Phone:

• Cell Phone:

Email

• Email Address:

Select Your

• Gender:
• Male        Female        

• T-Shirt size:
• SmallMediumLargeX-Large

Sponsoring Science Teacher

• Name:

• Email or Phone:

NOTE: The sponsoring teacher will be contacted by the FIRE Up team. Please talk to your sponsoring teacher before you begin filling out this online form.

Where Did You Hear About FIRE UP For Summer?