Dakota Dreams Career Exploration Summer Camps

Camper Information (required fields are marked with *)

Student First Name *

Student Middle Initial *

Student Last Name *

Preferred Name

Date of Birth * +

Sex *

Street Address *

Address Line 2

City *

State *

Zip Code *

School District attending in Fall 2023? *

Grade in Fall 2023 *

T-Shirt Size *

Did your student attended a Dakota Dreams Career Exploration Summer Camp in 2022? *

Yes

No

Will transportation be a barrier to your child’s attendance?

Yes

No

Reporting Purposes Only

This information is being collected for reporting purposes only and will not be considered as part of the selection process.

What is your Race? (select all that apply) *

Is your ethnicity Hispanic or Latino? *

Yes

No

Prefer not to answer

What is the highest level of education attained by either parent? *

Camper Preferences

Camp locations include the below (collectively and individually “Institution”):

Black Hills State University, partnering with South Dakota School of Mines & Technology and Western Dakota Technical College - June 25-29
Black Hills State University, partnering with South Dakota School of Mines & Technology and Western Dakota Technical College - July 9-13
Dakota State University, partnering with Mitchell Technical College - July 9-13
Northern State University, partnering with Lake Area Technical College - July 9-13
South Dakota State University, partnering with Lake Area Technical College - July 9-13
University of South Dakota, partnering with Southeast Technical College - June 18-22

We will make every effort to accommodate camp preference, but there is no guarantee that you will be assigned to your first choice.

First Preference *

Second Preference

Third Preference

Parent/Guardian Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Relationship to the Student *

Parent/Guardian Phone Number *

Email Address *

Check here to add a second parent/guardian.

Yes

Parent/Guardian First Name

Parent/Guardian Last Name

Relationship to the Student

Parent/Guardian Phone Number

Email Address

Emergency Contact Information (other than parent/guardian)

Emergency Contact Name *

Emergency Contact Phone Number *

Medical Information

Insurance Company *

Insurance Company Phone Number *

Policy Holders Name *

Policy Number *

Does the camper take any medications regularly? *

Yes

No

What medications are taken regularly and how often? *

How does medication need to be stored and distributed? *

Other Information

Does the camper have any allergies or dietary restrictions? *

Yes

No

Please list any allergies or dietary restrictions (Nut allergy, Gluten free, Vegetarian, etc.)

Does your child have a disability that requires a reasonable accommodation to participate in the program? *

Yes

No

Please list any special accommodations that your child requires to participate in this program

All participants are required to stay on campus during the program. Participants can indicate roommate preference, though there is no guarantee of placement. Note, both participants must select each other.

Roommate preference, if applicable

Other information the camp staff should know to help your student be successful? *

Camper Agreements

Checking ‘Agree’ below serves as your electronic signature on these waivers.

Informed Consent, Voluntary Waiver, Release of Liability and Assumption of Risks Waiver -- View Document *

Agree

Media Release -- View Document *

Agree

Opt Out