STARBASE Home School Student Registration


Waiting List Only

Prior to submitting this registration form, please click the link for the 148th Fighter Wing Security Form under the Security section below. This form is required for anyone age 16 or older who will be transporting your student(s) to or from STARBASE. Exception: Anyone with an active military or dependent ID.

Child Information
Child's First Name
Child's Last Name
Gender      
Date of Birth
Ethnicity   (reported in summary form only)
Grade Equivalent  in Fall of 2024
Special Learning Needs
Special Health Needs
Street Address
City
State
Zipcode
This child has participated in the STARBASE school year program before  
(Please limit school year participation to two (2) years.)
Click here if you have more children to register for STARBASE Home School
 
Child's First Name
Child's Last Name
Gender      
Date of Birth
Ethnicity   (reported in summary form only)
Grade Equivalent  in Fall of 2024
Special Learning Needs
Special Health Needs
This child has participated in the STARBASE school year program before  
(Please limit school year participation to two (2) years.)
 
Child's First Name
Child's Last Name
Gender      
Date of Birth
Ethnicity   (reported in summary form only)
Grade Equivalent  in Fall of 2024
Special Learning Needs
Special Health Needs
This child has participated in the STARBASE school year program before  
(Please limit school year participation to two (2) years.)
 
Child's First Name
Child's Last Name
Gender      
Date of Birth
Ethnicity   (reported in summary form only)
Grade Equivalent  in Fall of 2024
Special Learning Needs
Special Health Needs
This child has participated in the STARBASE school year program before  
(Please limit school year participation to two (2) years.)
Family Information
First Parent (the Parent employed at )
First Name
Last Name
Employer
Job Title   at
Work Email
Home Email
Work Phone
Home Phone
Mobile Phone
Use the same address as the Child
Street Address
City
State
Zipcode
Active Miltary ID?
This parent would like like to volunteer at STARBASE on        
Second Parent
First Name
Last Name
Employer
Job Title
Email
Phone
Mobile Phone
Use the same address as the Child
Use the same address as the First Parent
Street Address
City
State
Zipcode
Active Miltary ID?
This parent would like like to volunteer at STARBASE on        
Emergency Contact Information (in case parents cannot be reached)
First Name
Last Name
Relationship to Child
Phone
Emergency Instructions
Security Information
This form is required for anyone age 16 or older who will be transporting your student(s) to or from STARBASE.
Due to security requirements at the Minnesota Air National Guard Base, all adults entering the base must provide the information below which will be routed through Base Security. Please complete the information below for any adult who will be entering the base, whether they are driving or not. This information is required at the time of registration. Adults must show a photo ID upon entry.
Please download this PDF form: 148th Fighter Wing Security Form
Please return a completed copy of this security form for each adult who will dropping off our picking up your student. Please return to our secure mailbox: swolniakowski@starbasemn.org. Please type (secure) in the subject line to ensure secure transmission and delivery. Please note that this form must be received no later than one week before the first day of your student's session. Adults who have not cleared security in this manner (or who do not have an active military ID) will not be admitted on the base.
I hereby grant permission for the aforementioned minor(s) to participate in the STARBASE program listed above. This includes outdoor activities, classroom activities and field trips whereby my child(ren) may be transported by bus to a location on the 148th Fighter Wing or local business. I understand that participation is voluntary. I also understand that STARBASE Minnesota, Inc. reserves the right to terminate participation in the program when it is deemed to be in the best interest of either the participant or the program. I take full responsibility for any damage that might occur to government or STARBASE property caused by my child(ren). I further agree not to hold the United States Government, the State of Minnesota, the Minnesota National Guard, its officers, employees and agents, STARBASE Minnesota staff or volunteers supporting the program, liable for any reason as a result of participation in this program.
I acknowledge that photographs and video may be used from time-to-time to document and promote STARBASE Minnesota activities and hereby consent to the use of my child(ren)'s image for these purposes unless otherwise indicated in the Comments below.
Comments
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