Registration Form

We likely won’t be taking campers until 2024, but you can still get in touch with us today and have your questions answered.

So before you fill out the registration form, please email or call us, so that we can learn more about you and your child, in order to provide the best camp experience possible.

Participant Information

Participant's Name

First Name

Last Name

Birth Date

YYYY

School

School that participant is currently attending

Grade completed

Any allergies and/or medical issues?

If none, leave blank

List any medications you are currently taking

If none, leave blank

Parent/Guardian Information

-\- Parent/Guardian's name

Primary

First Name

Last Name

Are you the mother, father, or guardian?

Please choose one

Mother

Father

Guardian

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

-/- Parent/Guardian's name

Secondary

First Name

Last Name

Mother, Father, Guardian

Please choose one

Mother

Father

Guardian

Phone

(###)

###

####

Emergency Contact

If, in the event of a medical or other emergency, I am unable to be reached by telephone at my home or work telephone numbers listed ABOVE, I authorize the activity supervisor(s) to attempt to contact me through the emergency contact(s) listed BELOW.

Name

First Name

Last Name

Relationship to Child

Phone

(###)

###

####

Additional Information & Consent

Transportation to and from the camp:

Please indicate which mode of transportation your child will be using. Parents are responsible for securing transportation for their child, to and from the Hoffman Ranch. However, adult volunteers and chaperones will transport campers to various places in the area throughout the week. If your child will be traveling to camp via plane or bus, please arrange the time of arrival with us in order to coordinate pickup of other campers. Child may fly or take bus into Dickinson, ND, or Rapid City, SD, and a camp staff member will meet their plane or bus. If you will be driving your child to camp, we will provide you with directions. Directions can also be found on the "Contact" page.

Additional Comments

Please tell us anything else we should know about your child, including fears, anxieties, things he/she enjoys, or camp activities from which you would like your child to be exempt.

Statement Of Consent:

The child named above is in good health and has no physical or medical limitations that would cause the activities (as described in the “Camp Activities” page found elsewhere on this website) to be detrimental or dangerous to the child. I hereby attest that I am (we are) the legal parent\guardian(s) of the above-named child and hereby consent to the child's participation in all camp activities. I understand that camp activities may result in physical injury to my child but nonetheless specifically request that he or she be allowed to participate in those activities.

Permission to take photos:

I hereby give permission for images of my child, captured during camp Events through video, photo and digital camera, to be used solely for the purposes of Organization promotional material and publications, and waive any rights of compensation or ownership thereto.

Insurance & Emergencies

I/We understand that Hoffman Horizons does not carry any insurance relative to the activities or for any injury that may occur to the above-named child. I/We represent that the child is (a) covered by insurance through my own insurance carrier; or (b) that I/We am personally financially responsible for any and all medical costs incurred as a result of the child's injury.

Release & Identification

I release and waive, and further agree to indemnify, hold harmless or reimburse Hoffman Horizons, the individual members, agents, employees and representatives thereof, as well as activity supervisors, from and against, any claim which I, any other parent or guardian, any sibling, the above-named child, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses, damages or injuries arising out of, during, or in connection with the child's participation in the activities (including all forms of transportation) or the rendering of emergency medical procedures or treatment, if any.

~~~~~~~Agree to the Terms and conditions~~~~~~~

Upon completion of this form, a PayPal request will be emailed to you, where you can click the link to pay the camp tuition of $595.00. If you do not have a PayPal account, you can still use the secure link that will be provided, to pay with your credit card. Checks may be sent to: Hoffman Horizons Camp in care of Konnie Ellis, 2600 Plateau LN, Rapid City, SD, 57703 Additionally, if you believe your child would be eligible for a scholarship that would cover the costs of the camp, please send an email or message us through the "Contact" page on this website.

I, the parent/guardian, hereby attest that I have carefully read this Permission to Participate, understand its contents, and agree to its terms and conditions.

Agree

Date

YYYY

* Indicates a Required Field

Registration Form

Hoffman Horizons

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