2024 Summer Tech Team Registration Form

2024 Summer Tech Team
Registration

Please complete the 2024 Summer Tech Team Registration and Photo Consent forms below.
For questions please contact [email protected].

We will begin reviewing registration submissions on June 10. Registrations submitted before this date will receive priority.

Student Details

* Indicates required field

Student Name *

First

Last

Student Gender *

Student Date of Birth *

Parent/Legal Guardian Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Best Phone Number *

Parent Email *

What school does your child attend? *

YSA Summer Program Registration

Our summer programs are currently offered to students in 5th grade, middle school, and high school. Note that making the selections below does not guarantee a spot for your child in the program. We will always do our best to get your child in the program, but if space is not available then your child will be placed on a waiting list.

YSA's summer programs are free, and we are grateful for financial support provided by our donors and sponsors.

Parents and legal guardians are responsible for drop-off and pickup each day, YSA will not be able to provide transportation.

I would like to register my child for the following sessions: *

W-Fr June 12-14 (10a-1p) Tu, W & Fr June 18, 19 & 21 (9a-12p) Both weeks, 6 sessions

Emergency Medical History
This information will be kept confidential and secure on file in case of emergency.

Allergies or Asthma? *

Yes No

If yes, explain: *

Physical Disability? *

Yes No

If yes, explain: *

Dietary restrictions? *

Yes No

If yes, explain: *

Is your child up to date with his/her/their regular vaccine schedule? *

Yes No

If no, explain: *

Name family physician/practice *

Family physician phone *

In case of emergency please call: *

First

Last

Emergency Phone Number *

List names and phone numbers of anyone else other than yourself approved to pick up your child? *

Acknowledgement of Registration Conditions

required *

I agree

I understand, agree and acknowledge that my child’s participation is not the responsibility of the Young Scientist Academy (YSA), its employees, volunteers, officers, or agents. I affirm and agree that as parent/legal guardian, I will grant the approved supervisors, educators, volunteers 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 acknowledge that I expressly agree to assume any such risks on my behalf and that of my child.

Digital signature of parent or guardian *

relationship to student *

date *

YSA Photo/Video Consent Form 2024

Staff, board members, approved volunteers, student interns and/or hired photographers of Young Scientist Academy often take photographs and/or video for educational or publicity purposes. These images and videos may appear in YSA promotional materials or on our website and social media platforms.

Please note that websites can be viewed throughout the world, not just in the United States. This form is valid for five years from the date of signing.

I agree to allow the Young Scientist Academy to use my child’s image(s) and video in publicity materials produced by YSA, including printed publications, digital films, in-house presentations and on our website and social media. This is valid for the next 5 years. *

Agree

Student Name *

First

Last

Parent or Legal Guardian Name *

First

Last

Relationship to Student *

Digital Signature *

Date of Signature *

I agree to receiving marketing and promotional materials *

Submit

2024 Summer Tech Team​Registration

2024 Summer Tech Team
Registration