YOUNG SCIENTIST ACADEMY PRE-REGISTRATION FORM
"YSA Science Homeschool Program"
Indicates required field
Date of Birth
Parent/Legal Guardian Name
Best Phone Number
Please Specify if your child has completed any public of private school education.
What grade level will your child be in the 2019/2020 school year?
What grade level do you think your child can realistically complete? (can be the same or higher level as current grade level)
Relativeto their school level, how experienced is your child in science and mathamatics?
No Experience At All
What science-related needs would your child like to learn in our homeschool program?
Reading & Comprehension
Geology & Earth Science
Climate Science & Meteorology
If other, please specify topics:
Please provide any other comments about your child's expectations or education history.
I agree and acknowledge that following official registration in the YSA Science Homeschool Program, 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 agree to pay the one time application fee (non refundable) of $25 and that program tuition is due before the start of each module or session. I also grant YSA permission to photograph and video my child, and publish these images on the YSA website and affiliated social media platforms.
Signature of Parent or Guardian
relationship to student