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    2021 Code Niñas Registration Form

    For questions, please email Dr Rob at rob@ysa.world

    Applicant Details

    MM/DD/YYYY

    Program Requirements

    Due to the generosity of the Jeff Gordon Chevrolet and nCino, the Code Niñas program is completely free. Throughout the semester, participants will receive a Code Niñas t-shirt and lanyard as well as other swag .

    Please provide brief (3-4 sentences) responses to the following questions:

    I agree and acknowledge that my child’s participation is not the responsibility of the Young Scientist Academy (YSA) or the Harrelson Center, its employees, officers, or agents. I affirm and agree that as parent/legal guardian, I will grant the approved supervisors, educators and chaperones from YSA the responsibility to supervise my child during YSA activities and field trips. I further agree and understand there are inherent risks attendant to these activities – including but not limited to personal injuries that may be sustained while participating in YSA activities.  I expressly agree to assume any such risks on my behalf and that of my child. I also grant YSA permission to photograph and video my child, and publish these images on the YSA website and affiliated social media platforms.   
    MM/DD/YYYY
Submit
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Young Scientist Academy // 501(c)(3) EIN 81-4999928
Suite 420, 20 N 4th Street
Wilmington, NC 28401
Ph: (910) 386-1867
  • Home
  • About
    • Our Mission
    • Our Space & Facilities
    • Our Team
    • Our Impact
  • Programs
  • Calendar
  • Contact
  • Donate