SDSP Chapel Visit Request Form
Full Name of Requestor:
First Name
Last Name
Date and time of visit:
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Internal Group, Department or Individual you will be coming in with:
External Organization or Affiliation:
Our church is in partnership with St. Dysmas Lutheran Church inside the South Dakota Penitentiary system. As part of that partnership, we are invited to attend worship with the congregation. I participate only in that spirit of fellowship and support, with no intent other than to join in worship. I do not represent any other organization, group, or faith tradition, and I bring no message or purpose beyond being present as a respectful guest and fellow Christian.
Purpose and Scope of Visit (Not required if box checked above)
Please briefly explain your reason for requesting entry into the correctional facility, including your objectives and anticipated outcomes. If your purpose includes worship services, religious programming, volunteer activities, or other services, explain your motivation rather than simply listing the activity.
Signature:
Date:
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Submit
Should be Empty: