FSL Registration Registration Open! Sciencenter Membership Number(Required)Email(Required) Future Science Leader (FSL) Name (First & Last)(Required)FSL Pronouns (optional)FSL Date of Birth(Required)mm/dd/yyyyFSL Grade (2025-2026 Academic Year)(Required)6th Grade7th Grade8th GradeFSL School (or Home Schooled)(Required)FSL Member's Email (optional)If shared, this email will be included on relevant program communications, including meeting reminders.Parent/Guardian Contact Information(Required)NameRelationship to Future Science LeaderEmailPhone Add RemoveAll emails listed will receive regular program communications. Parents/guardians will double as emergency contacts. Additional Emergency Contact (optional)NameRelationship to Future Science LeaderPhone Add RemoveFSL takes place in the Teen STEM Lab, which is only accessible by stairs. We are happy to make accommodations and can change the location if needed. Is your Future Science Leader able to navigate stairs? Yes No Additional NotesPlease use this space to share any information that will assist program staff in providing a safe, engaging experience for your Future Science Leader!Permissions(Required) I give permission for the FSL registrant to:Receive emergency medical treatment at the discretion of program staff in the event that injury or illness should occur during their participation in the Future Science Leaders program, after program staff has made every reasonable attempt to get in touch with listed legal guardian(s) and designated emergency contact(s). Participate in program-related activities conducted by the Sciencenter. I hereby release, indemnify and hold harmless the Sciencenter from any and all liability in respect to any loss, damage, or claim of any nature whatsoever arising out of or in any way related to my child’s participation in the Future Science Leaders program, provided that such loss or damage was not caused solely by the fault or active negligence of the Sciencenter or its staff. Walk off-site to local areas such as Stewart Park, the Ithaca Farmer’s Market pavilion, the Sagan Planet Walk, and Cascadilla Creek, and to tour other facilitiesProgram Supervision(Required) I understand that there is no formal sign-in or sign-out procedure for FSL program activities. At the end of each meeting, FSL participants will be released from supervision. Youth, age 12 and above, may stay in the Sciencenter unsupervised outside of program hours. Membership Requirement(Required) I understand that my household must have a current membership at the Sciencenter at the time of registration. There is no additional fee for participation in the FSL program. If the cost of a membership is financially prohibitive, please stop by the museum’s Front Desk during open hours or reach out to membership@sciencenter.org to inquire about our Membership Access Program! Photo/Video Release I grant the Sciencenter and its representatives permission to photograph and/or videotape me and/or my child. I also grant the Sciencenter permission to put the finished product to any uses it may deem proper, including, but not limited to: print materials, media releases, advertising, online and social media. I understand that the Sciencenter does not provide monetary compensation and that photos may be shared with Sciencenter partner organizations. Parent or Guardian Signature (type your name below)(Required)
