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    YOUNG SCIENTIST ACADEMY REGISTRATION FORM:
    "YSA Summer Science Camp Program"

    Payment for YSA programs can be made via credit card, PayPal, bank transfer, cash or check and customers will be invoiced for payment  following submission of the registration form. Full payment will secure spot in our summer camps.
    MM/DD/YYYY
    Emergency Medical History
    This information will be kept confidential and secure on file in case of emergency.

    ​Payment Information
    Prices below reflect the Early Bird Discount, full prices will apply after March 31, 2020.
    A non-refundable application fee of $25 per child applies to all first time registrants.
    ​Payment Options: 
    Payment for YSA programs can be made via credit card, PayPal, bank transfer, cash or check and customers will be invoiced for payment  following submission of the registration form. Full payment will secure spot in our summer camps.
    Credit card payments are made online through Quickbooks (3.4% surcharge applies). Customers will be invoices following submission of the "YSA Registration Form". Checks should be made payable to "Young Scientist Academy".
    ​​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 agree to pay the one time application fee (non refundable) of $25 and that program tuition and associated fees are due before June 1, 2020. 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
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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
  • DONATE
  • Code Girls
  • Programs
    • Afterschool Science Ambassadors Program (ASAP)
    • Youth CAUSE Initiative
    • Homeschool Science
    • Latinx Science Seminars
    • Virtual Experiences
  • About
  • Scholarships
    • Apply for a Scholarship