• St. Dysmas Worship Service Visitor Form

    ***Please read, complete, and submit this page with your access forms***

  • A maximum of 6 visitors are allowed to worship with St. Dysmas each Thursday afternoon within the walls of the SDSP in Sioux Falls. Visitors must be 18 years of age or older.

    Because of limited space, only submit paperwork if you fully intend to attend a worship opportunity.

    Visitors are considered volunteers and are REQUIRED to complete:

    • St Dysmas Worship Service Visitor Form
    • Please completely read the Guidelines for Worship forms
    • DOC-Background Check Authorization (2 pages)
    • DOC-Release and Waiver of Liability form
    • SDSP Chapel Visit Request Form
    • DOC-Consent to Search Authorization and Registration forms


    Each form must be filled out COMPLETELY (Yes, we MUST have your social security number!) and CORRECTLY or you will not be approved to join worship.

    Completed forms submitted 3 weeks prior to the scheduled visit date.

    Items for special music or presentations must be approved in advance. Any medical device you may need must also be pre-approved. Please contact the St. Dysmas office for more information.

    When available, visitors are invited to meet following the service for supper, conversation, and a time of fellowship at the Fryn' Pan, 2708 E 10th St., Sioux Falls. Each person pays their own expense. This time provides a chance to visit about your prison experience, an opportunity to ask questions about prison life, and to learn more about St. Dysmas.

    If you would like to meet at the Fryn' Pan, please notify us 3 weeks prior to your visit day.

    Your visit to worship with St. Dysmas is important and they greatly appreciate your attendance!

  • Date of intended visit
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Preferred contact

  • Questions? Call the St. Dysmas office at (605) 338-1735 or email visit@stdysmas.com

    Pr Jeff Backer's cell phone at (605) 360-3409, Pr Laura Phillip's cell phone at (605) 359-6294

  • Guidelines for Worship
    St. Dysmas Lutheran Church

    South Dakota State Penitentiary (SDSP)
    1600 North Drive, Sioux Falls, SD
    St. Dysmas office: 605-338-1735

  • PLEASE BE IN THE PRISON ENTRANCE - LOBBY
    BY 6:30 PM READY TO GO IN
    YOU WILL NEED YOUR DRIVERS LICENSE OR
    GOVERNMENT ISSUED PICTURE ID.

     The name on your DOC Access form must appear exactly as it does on your driver's license 

    • Your visit to a St. Dysmas worship is important. The members of our congregation greatly appreciate your attendance! It is a way for them to maintain contact with the outside world, worship with fellow sisters and brothers in Christ, and to know they have not been forgotten. Your time with St Dysmas directly corelates to what our Lord speaks of in Matthew 25 and Hebrews 13; to visit those in prison.

    • ALL VISITORS ARE RESPONSIBLE TO KNOW THE POLICIES AND RULES AS OUTLINED IN THE VOLUNTEER HANDBOOK.

    • DRESS CODE for prison visitation is conservative.

      Clothing NOT ALLOWED:
      • Hats or any headwear (including bandanas)
      • Hooded sweatshirts
      • Open-toe shoes, flip flops
      • Shirts/tops of the following nature - tank, spaghetti strap, midriff, tube, shoulder-less, back-less,halter, or low cut.
      • NO SHORTS!!
      • NO SKIRTS OR DRESSES!!
      • Stretch or yoga pants
      • Tight jeans, Low-rise pants which allow skin or undergarments to be

    • Pockets must be emptied of all items unless pre-approved (keys, wallets, pens, knives, cell phones, candy/cough drops/gum). Any medications you MUST have with you must be pre-approved.

    • Items not allowed to be taken into prison: No gum, food, cameras, purses, coats, pocket-knives, tobacco products, smart watches, fit-bits, cell phones, beepers, or any other type of wireless or electronic devices (even if turned off or set to vibrate). They can be left in your car or stored in a locker in the lobby (cost is 25c).

    • Screening and/or pat-down searches are required for all visitors.

    • Please be quiet in the Sally Port. If the officer needs to say something it is difficult to talk over others through the glass. Visitors will turn in their ID and will receive a prison ID and body alarm to use while inside the prison.

    • Visitors should sit among the men in small groups of two to three people. A handshake is the only allowed physical contact between a visitor and offender.

    • DO NOT ask offenders why they are incarcerated, ask for, or accept, an offender's mailing address, offer help or promise favors. DO NOT give out your personal information such as your full name, address or phone numbers to offenders. There are proper channels for offenders and families if they need help.

    • A restroom is available in the prison lobby after the screening process. A restroom is NOT available once you are inside the secure area, so please be sure you are set before entering the prison.

    • If you are sick or not feeling well, please do not attend.

    • For those with limited mobility, please notify us of your needs. We will try to accommodate your needs to attend worship.

    • Questions? Call the St. Dysmas office at (605) 338-1735, Pastor Jeff Backer's cell phone at (605) 360-3409, or Pastor Laura Phillip's cell phone at (605)359-6294.

    Visiting inside the prison is not an easy task, and the SD DOC appreciates your time and effort. Following a few simple rules and understanding will help you to maintain respect and establish positive interactions.

    The following guidelines will help to provide a positive experience when visiting.

    Visitors are expected to demonstrate professionalism and integrity while interacting with offenders.

    The following is not allowed:

    • Hugging
    • Kissing
    • Physical contact other than a handshake.
    • Being alone with an offender
    • Sexual contact
    • Sexual harassment and/or discrimination is expressly forbidden.

    Do:

    • Be friendly, but avoid familiarity
    • Always be professional and maintain healthy boundaries.
    • Offer encouragement.
    • Offender manipulation:

    Offender manipulations:
    Offenderswmay be expressed through a variety of ways. Some examples are:

    • Asking you to bring in contraband items.
    • Asking you to take something out for them.
    • Asking you to contact a friend or family member with a message.
    • Becoming personally involved.
    • Asked to write to them or be added to their phone list.

    Never be shy about saying "NO" to a request you are uncertain of, or that you clearly know is against policy.

    Always keep in mind that even though a request may seem insignificant the outcomes could generate safety concerns for you, staff, or other offenders.

    When in doubt, inform the offender that you will need to check with staff regarding their request.

    Do not be afraid to ask for guidance from St Dysmas staff or the prison staff when you have questions.

    Your role as a visitor is to provide encouragement and a positive influence to those incarcerated. Any visitor who believes or experiences an inappropriate relationship with an offender beyond a professional level must report the information to St Dysmas staff and/or DOC security staff immediately.

    I have read and understand the guidelines stated above:

     

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • BACKGROUND CHECK AUTHORIZATION

  • CHECK ONE:
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • I hereby authorize the South Dakota Department of Corrections, or its designated agents and representatives, to obtain and review my criminal background. I certify that the information given by me is true, complete, and correct, to the best of my knowledge and belief and made in good faith. The DOC and its designated agents or representatives shall maintain all information received from this authorization in a confidential manner in order to protect my personal information, including, but not limited to, addresses, social security numbers, and dates of birth.
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • SECURITY QUESTIONNAIRE

  • Please answer the following questions to the best of your knowledge. If you have any questions or you are unclear about a question, please discuss it in the interview.
  • 1. Have you ever been convicted of a felony or misdemeanor?
  • 2. Have you ever heen convicted of any misdemeanor crime related to domestic violence?
  • 3. Have you been charged with a felony or misdemeanor in which a conviction determination is pending?
  • 4. Have you ever been convicted of DUI, DWI, or a related offense?
  • 5. Have you ever engaged in any sexual abuse in a prison, jail, lockup, community confinement facility, juvenile facility, or other institution?
  • 6. Have you ever been convicted of engaging or attempting to engage in sexual activity in the community facilitated by force, overt or implied threats of force, or coercion, or if the victim did not consent or was unable to consent or refuse?
  • 7. Have you ever been civilly or administratively adjudicated to have engaged in the activities described in the previous question?
  • 8. Do you know anyone incarcerated in a correctional facility?
  • 9. Do you know anyone who has ever been incarcerated in a correctional facility? This includes anyone who is or has been on parole.
  • 10. Have you ever served as a sponsor for an offender?
  • 11. Do you know anyone who works for the South Dakota Department of Corrections (SDDOC), or has ever worked for the SDDOC?
  • 12. Do you use illegal drugs of any type?
  • 13. Have you ever been terminated for cause from any job?
  • 14. Have you ever been in the United States military service?
  • 15. If so, have you ever been discharged from the United States military service under less than honorable conditions?
  • I certify that the information I have provided is true, correct, and complete to the best of my knowledge and belief. I understand that misrepresentation, falsification, or omission of facts called for in this questionnaire is cause for cancellation of my application.
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • DOC RELEASE AND WAIVER OF LIABILITY

  • By my signature below, I acknowledge that I am aware of, appreciate the character of, and voluntarily assume the risks associated with being on DOC properly, or participating in DOC activities within the following facilities:

    South Dakota State Penitentiary, Jameson Prison, Sioux Falls Minimum Center, Mike Durfee State Prison, Yankton Minimum Center, Rapid City Correctional Facility, Rapid City Minimum Center, South Dakota Women's Prison, or Pierre Minimum Center.

    I understand that risks associated with such entry and/or participation in DOC activities include, but are not limited to, bodily injury, property loss or damage and death.

    By my signature below, on behalf of myself, my heirs, next of kin, successors in interest, assigns, personal representatives, and agents, I hereby:

    1. Waive any claim or cause of action against and release from liability the State of
      South Dakota, its officers, employees, and agents for any liability for injuries to my person or property resulting from such entry and/or participation in DOC activities.
    2. Agree to indemnify and hold harmless the State of South Dakota, its officers,
      employees, and agents for any claims, causes of action, demands, expenses, judgments, fees and costs of whatever kind or character arising from, by reason of, or in connection with my entry to a DOC facility or participation in DOC activities.

    I have carefully read this RELEASE AND INDEMNITY AGREEMENT, or had it read to me in a language I fully understand, and I understand all of the terms. I understand I have given up substantial rights by signing this agreement and that it is the intention of the parties that the State and its officers, agents and employees shall not be liable or in any way responsible for injury, damage, liability, loss, or expense resulting to me due to accidents, mishaps, misconduct, negligence, or injuries. My signature below has been made freely and voluntarily without any inducement, assurance or guarantee being made.

  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date:
     - -
    2 digit month, 2 digit day, 4 digit year

  • SDSP Visit Request Form

  • Date:
     - -
    2 digit month, 2 digit day, 4 digit year

  • CONSENT TO SEARCH AUTHORIZATION AND REGISTRATION - VISITORS

  • A DOC Facility is: A place, institution, or building (or part thereof), set of buildings, or area (whether or not enclosing a building or set of buildings) that is used for the lawful custody and/or treatment of individuals. It may be owned and/or operated by public or private agencies and includes the staff and services as well as the buildings and grounds.

    1. Under the provisions of South Dakota law, the following items are declared contraband inside a correctional institution. Guests will not introduce or attempt to introduce these items into this facility or at any location where an offender is likely to be located while such offender is in the custody and under the jurisdiction of a political suhdivision of the State of South Dakota or the Department of Corrections, but not on parole.

    1. Any dangerous instrument: A firearm, explosive device, or substance (including ammunition), knife or sharpened instrument, poison, acid, bludgeon, or projective device, metal utensil/drinking straw, or any other device, instrument, material, or substance which is readily capable of causing or inducing fear of death or bodily injury, the use of which is not specifically authorized.
    2. Alcoholic beverages.
    3. Controlled substances.
    4. Key pattern, key replica, or lock pick.
    5. Any tool or instrument that could be used to cut fence or wire, dig, pry, or file.
    6. Any un-canceled postage stamp or implement of the United States postal service.
    7. Any counterfeit or forged identification card.
    8. Any combustible material.
    9. Any drug, other than a controlled substance, in quantities larger than two (2) doses unless otherwise prescribed.
    10. Any mask, wig, disguise, or other means of altering normal physical appearance which could hinder ready identification.
    11. Any drug paraphernalia: all equipment, products, and materials of any kind which are used, intended for use, or designed for use in planting, propagating, cultivating, growing, harvesting, packaging, repackaging, storing, containing, concealing, injecting, ingesting, inhaling, or otherwise introducing into the human body a controlled substance in violation of the laws of this state.
    12. Any chain, rope, or ladder.
    13. Any cigarettes, tobacco products, chewing tobacco, vape pens/devices, or vape cartridges.
    14. Any Bluetooth enabled device and/or portable electronic communication device including but not limited to cell phones, smart glasses, smart watches, public, private, or family style radios, pagers, personal digital assistants, any other device capable of transmitting or intercepting cellular or radio signals, and portable computers; except those devices issued and authorized by the SDDOC.
    15. Any article or thing that poses or may pose a threat to the security of the SDDOC facility/office as determined by the warden. This shall include but not be limited to: matches, cigarette lighters, any substances used for brewing or making intoxicating beverages, any counterfeit or forged medium of exchange, or paraphernalia used to produce this medium, any batteries, cameras, film, flashbulbs, flashlights, pets (unless authorized through a facility dog program), plant life, or any article or substance that is not specifically allowed by this facility.

    1. Penalties:

    1. Anyone violating section A is subject to an investigation and may be barred from the facility and is subject to criminal prosecution.

    1. Declaration of Consent and Waiver:

    1. Any person entering a DOC facility without a permanent DOC ID badge will have a background check completed, prior to entry into a facility or onto DOC owned property. When possible, a completed copy of this form, must be received ten (10) days in advance of the anticipated date of access.
    2. As a condition of entering the property of South Dakota Department of Corrections, I hereby consent to search of my person and/or any of my personal property, or of the person of any minor children accompanying me. I also acknowledge any vehicle that I may bring on the grounds of this facility may be searched when reasonable suspicion arises that I have/am violating DOC policy/SD law as it relates to the introduction of contraband. I acknowledge that I have the opportunity to leave the facility immediately if I choose not to give this consent to search.
    3. I hereby declare that I have read and understand and will abide by the provisions above. I understand that violation of any of the above provisions, or the entering of any false information on this form may result in my being banned from or denied access to any of the South Dakota Department of Corrections' facilities.

  • Section 1: Guest Data

  • Date of Visit
     - -
    2 digit month, 2 digit day, 4 digit year

  • Section II: Guest Vehicle Data

    If you were a passenger, you must identify the car in which you arrived.

  • Section III - Guest Data

  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • The information I have provided is correct and I have read and understand the Declaration of Consent and Waiver.
  • Date:
     - -
    2 digit month, 2 digit day, 4 digit year
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  • Should be Empty: