STARBASE Summer for 4th to 6th grade

A Science, Technology, Engineering and Mathematics (STEM) Camp. This is different from our 1.0 program. The camp will be 20 hours long, over 4 days, 5 hours each day. Don’t worry if your student has or hasn’t attended STARBASE in the past. We will re-introduce topics and expand on them. Robots, Mapping and GPS Geocaching, CAD and 3-D printing, chromatography are just some of the topics we will cover. Space is limited to 20 per session, students work in groups of 4. The program is free to all, We do not provide transportation or food. There is not a cooking facility available, sack lunches required.

8/07 to 8/10 Monday – Thursday from 9am to 2pm

Sign in to Google to save your progress. Learn more
Email *
Student First Name *
Student Last Name *
My child is in grades 4 - 6.
Clear selection
Parent / Legal Guardian (First and Last Name) *
Parent / Legal Guardian Cell# *
Have the student's parents/guardians served in the military? (Note: This is not a requirement to attend)
Clear selection
Participation in STARBASE classes is on a first come, first served basis. Each camp has a cap of 20 students, the first 20 complete applications will be enrolled. *
Required
Parents / Legal Guardians will be responsible for driving their children to and from STARBASE on each scheduled day of class. Class will begin promptly at 9:00 AM and end at 2:00 PM. *
Required
Would you like to authorize another person to pick up your child from STARBASE? Please enter their information here: (First name, last name, phone number.)
Medical Information: Please include any known allergies or other information you would like STARBASE staff to be aware of, taking into account we will often be outdoors and walking?
Please be aware that STARBASE sites are not permitted to administer medication of any kind to students. STARBASE facilities do not have an onsite school nurse. *
Required
Special needs: Please list any special needs requirements you would like STARBASE teachers to be aware of (Example: My child will require extra time or assistance with reading activities)
Person to contact in case of emergency: *
Emergency Contact Telephone: *
I will take full responsibility for any damage that might occur to government/STARBASE property caused by my child. Should such participation result in injury or illness, I agree not to hold the US Government, National Guard and State of Oregon, its employees, STARBASE personnel or agents liable in any way. I also understand that STARBASE reserves the right to terminate the participation of my child if it is deemed to be in the best interest of either the child, or academy, as determined by the STARBASE staff. *
Required
In case of emergency, I authorize STARBASE Oregon staff to obtain emergency medical care for my child or ward if they deem necessary. I agree the cost of such medical care is my responsibility. *
Required
Photo Release Permission Form: STARBASE Oregon would like to include your child’s picture and/or schoolwork in future media publications or on our website. Students will NOT be referred to by name, just by STARBASE academy and date. (Example – STARBASE Rilea student in October, 2022.) *
Dress Code: Students should dress appropriately for outdoor activities on each day of class. *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy