Black Hills Family Retreat Registration Form
List Name of Each Person Age Gender
__________________________________ ___ M or F
__________________________________ ___ M or F
__________________________________ ___ M or F
__________________________________ ___ M or F
__________________________________ ___ M or F
__________________________________ ___ M or F
Return Completed
Form And Payment To:

Pastor Michael P. Enderle
PO Box 98
Clear Lake, SD 57226
ph. 605-874-2449
trinity@itctel.com
Address ______________________________________________________________

City State Zip _________________________________ Phone ____________________
Lodging
Mark you preference 1st choice; 2nd choice; 3rd choice; 4th choice
_____
Cabin Each cabin sleeps 8 which will be shared with others. The cabins have toilets, single beds, and fireplaces (wood provided). Some cabins are carpeted, others are not. If you have another family or group you want to stay with, list the names of the other individuals, otherwise cabins will be assigned on a first registration basis. _______________________
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Tent (20% reduction in fees)
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RV (15% reduction in fees) ___ 5 spots with electricity & water or ___ 2 spots with electricity only (First to register for these spots will have priority.)
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Lodge The lodge rooms sleep 3 - 6 persons in single beds.
Please note - there are communal showers and sinks for cabin, tent, RV, & lodge users.
Camp Fees - Room & Board

 

Cabin or
Lodge

RV

Tent

 

Part-time Attendee

Adults (18 & above)

$53.50

$38.45

$36.20

Breakfast

$5.50

Youth (10 -17 years)

$40.50

$29.75

$28.00

Lunch

$6.00

Children (4 - 9 years)

$30.00

$22.10

$20.80

Supper

$6.75

Children (3 & under)

No charge

No charge

No charge

Sunday Brunch

$7.75

(Please register children under 3 - we need to know how many are attending.)
$__________ Camp Fees (Room & Board - see above information)
$__________ Registration Fee ($5 per person 4 years & older - max. $25 per family)
$__________ Total Fees (Room & Board + Registration Fees)
Full payment must accompany registration. All payments are non-refundable.