`South Dakota Black Hills Summer Camp Registration`

First Name:
Last Name:
Address:
City:
State:
Zip Code:
Phone:
E-mail:
Full time camper
Part time camper (don't foget to fill in part time info below if you clicked this)

Age Group (see below for children under 18): 18-29 30-35 36-50 51-65 over 65

Accommodations:

Roommate Preference:

Registering children under 18? Click here.

Please list any special needs:

Please list any special talents:

Are any of the registrants above first time campers? Yes No

If Yes, who? :

Check this box if you would like a copy of this registration form forwarded to the email address you listed at the top of this registration page.