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. _______________________
_____ Tent (20% reduction in fees)
_____ 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.)
_____ 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.