STARBASE Explorers STEM Camp
Registration
Waiting List Only

I acknowledge that I am an employee of

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)
T-Shirt Size
Child's School
District
Grade Level  in Fall of 2024
Special Learning Needs
Health or Physical Conditions
Street Address
City
State
Zipcode
This child participated at STARBASE Camp in  
Please note if your child has already participated twice at STARBASE camp they are not eligible to register for 2024.
Click here if you have more children who will attend STARBASE
 
Child's First Name
Child's Last Name
Gender      
Date of Birth
Ethnicity   (reported in summary form only)
T-Shirt Size
Child's School
District
Grade Level  in Fall of 2024
Special Learning Needs
Health or Physical Conditions
This child participated at STARBASE Camp in  
 
Child's First Name
Child's Last Name
Gender      
Date of Birth
Ethnicity   (reported in summary form only)
T-Shirt Size
Child's School
District
Grade Level  in Fall of 2024
Special Learning Needs
Health or Physical Conditions
This child participated at STARBASE Camp in  
 
Child's First Name
Child's Last Name
Gender      
Date of Birth
Ethnicity   (reported in summary form only)
T-Shirt Size
Child's School
District
Grade Level  in Fall of 2024
Special Learning Needs
Health or Physical Conditions
This child participated at STARBASE Camp in  
Family Information
First Adult (the Parent employed at )
Relation to Child
First Name
Middle Name
Last Name
Employer
Job Title
Work Email
Home Email
Work Phone
Home Phone
Mobile Phone
Use the same address as the Child
Street Address
City
State
Zipcode
Active Military ID?
This adult would like like to volunteer during Camp on        
Second Adult
Relation to Child
First Name
Middle Name
Last Name
Employer
Job Title
Email
Phone
Mobile Phone
Use the same address as the Child
Use the same address as the First Adult
Street Address
City
State
Zipcode
Active Military ID?
This adult would like like to volunteer during Camp on        
Voluntary Contribution
A $100 or more per child contribution may be made at the time of registration.
STARBASE is a 501(c)3 nonprofit organization whose mission is to educate and inspire youth in science, technology, engineering, and math for greater academic and lifelong success. Our organization relies on community support to be able to offer this unique and high quality program. The summer camp program is free to any student and a donation is not required to attend. After this form is submitted you will have the opportunity to make a voluntary contribution using a credit or debit card via PayPal - even if you don't have a PayPal account. If you choose to make a gift to the program, please print the confirmation page as a receipt that can be used for tax purposes.
You can maximize a contribution by utilizing any matching donation programs at your place of employment.
I would like to contribute $
You may use your credit card or PayPal to make your contribution, and will be prompted to enter payment details after this form is submitted. After making your payment, please print the thank you letter on the confirmation screen as a receipt to be used for tax purposes.
Emergency Contact Information (in case parents cannot be reached)
First Name
Middle Name
Last Name
Relationship to Child
Phone
Emergency Instructions
Scientist and Engineer Volunteer Opportunity
We invite all scientists and engineers to share a short demo related to an aspect of your or your corporation's work and information about your STEM career with our summer program participants. As a volunteer scientist or engineer, you will present a short, interactive demo of your choice to three small groups. We can work with you on ideas for your demo. Help us inspire a future in STEM with our summer program participants! This event is held on day 3 of the summer program and runs from 12:00 pm to 12:30 pm, arriving at 11:45 am to set up.
Volunteer Options Scientist/Engineer Talk (Day 3, 12-12:30)
Volunteer
Last Name
First Name
Relationship to Child
Email
Phone
The STARBASE volunteer coordinator will contact you soon with more information about this opportunity.
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 the vehicle or not. This information is required at the time of registration. Adults must show a valid photo ID upon entry.
Please download this PDF form and submit a separate form for each person coming to the base: 148th Fighter Wing Security Form
Please return your completed copies of this security form to our secure mailbox: swolniakowski@starbasemn.org. Please note that this form must be received no later than one week before the first day of your student's summer camp 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.
Adult One
First Name
Middle Name
Last Name
U.S. Citizen?
Active Miltary ID?
Adult Two
First Name
Middle Name
Last Name
U.S. Citizen?
Active Miltary ID?
Adult Three Use for additional adults
First Name
Middle Name
Last Name
Relationship to Child
U.S. Citizen?
Active Miltary ID?
Adult Four Use for additional adults
First Name
Middle Name
Last Name
Relationship to Child
U.S. Citizen?
Active Miltary ID?
Ridesharing
If you will be ridesharing, please use the box to list the names of any parents/guardians who also have Explorer campers and are authorized to drop-off or pick up your child from camp.
Camp Friends
If you have a request for your child to be grouped in the same class with another student or students, please list the names below.
Terms
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 STEM corporation. I understand this 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 participation 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.
 Check this box to agree to the terms above.
I acknowledge that photographs and video may be used to document and promote STARBASE Minnesota activities on websites, promotional materials, social media or other, and hereby consent to the use of my child(ren)'s images for these purposes unless otherwise indicated below.
 Check this box to agree to the photography and video terms above.
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