Virtual Mining and Explosives Summer Camp (Middle School)

*Required Fields

PARTICIPANT INFORMATION:

*First Name

Preferred Name (used in official communications)

Middle Name

*Last Name

Student Cell Phone

*Student Email Address

*Mailing Address

Country

Street

City

Region

Postal Code

*Birthdate

*Grade of camper during 2023-24 school year

Hispanic:

Yes

No

*Sex (as assigned at birth)

Female

Male

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Gender

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Pronouns

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High School

How did you hear about South Dakota Mines camps?

*PARENT/GUARDIAN INFORMATION:

*Parent/Guardian First

*Parent/Guardian Last

*Relationship

*What is the highest level of education completed by either parent/legal guardian?

*Parent Email Address

*Parent Cell Phone

MEDIA AUTHORIZATION:

By completing payment/registration, I hereby authorize the South Dakota School of Mines & Technology, hereafter referred to as “University”, to publish photographs or video taken of me for use in the University’s print, online, and social media marketing materials, as well as other University publications. Should you choose to opt out of the media release, please email Brittani Webb at Brittani.Webb@sdsmt.edu.