Summerville RFKC Virtual Camp Camper Application 2020

Virtual Camp Application. DO NOT PRINT THIS APPLICATION...It Must be filled out and submitted online. If you have problems completing the form, please contact us directly. This form will provide information for this year's virtual camp and allow us to contact you for next year as well. We will be developing and building virtual camp packages and intend to distribute those before August. Please be courteous and contact us if circumstances or contact information changes.
Questions?

IF YOU HAVE QUESTIONS about RFKC: Please contact us at Summervillerfkc@gmail.com or, Chuck Peterson at 843-568-3352
Name of Person Filling Out This Application *

First Name Last Name
Relationship To Child *

Caseworker Caregiver
Child's Information
Child's Name *

First Name Last Name
Preferred Name (if child has one)
If child is a returning camper and had a DIFFERENT NAME LAST year, please let us know!

First Name Last Name
Gender *

Male Female
Birth date *

Month Day Year
Age at Time of Camp (July 20, 2020) *

7 years old 8 years old 9 years old 10 years old 11 years old
Child's T-Shirt Size *

Child Medium Child Large Adult Medium Adult Large Adult Extra Large
Is this child a returning RFKC Camper? *

Yes, returning RFKC Camper No, not a returning RFKC Camper Don't know if child has been to RFKC before
If you know the name of the camper's counselor, please let us know.
Parent/Guardian Information
This home is best described as... *

Foster Home Adoptive Parents Group Home Kinship Biological Parent(s)
Home Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Parent or Legal Guardian #1 *

First Name Last Name
Relationship to Child *
Best Phone Number *

Area Code Phone Number
This phone is a:

Cell Phone Work Phone Home Phone (land line)
Parent/Guardian #1 Email Address
Parent or Legal Guardian #2

First Name Last Name
Relationship to Child
Parent or Legal Guardian #2 Best Phone Number

Area Code Phone Number
This phone is a:

Cell Phone Work Phone Home Phone (land line)
Parent/Guardian #2 Email Address
Cell Number for Authorized Adult *

Area Code Phone Number
Cell Number For Authorized Adult

Area Code Phone Number
Caseworker/Child Placement Agency Information
Caseworker Name *

First Name Last Name
Caseworker Email *
Caseworker Agency *
Example: Charleston Co. Berkeley Co., Bair, Mentor, Eagle Harbor, Lifeline Child
Caseworker Phone 1 *

Area Code Phone Number
Date *

Month Day Year
Enter the message as it's shown *
Should be Empty:

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Questions?

Child's Information

Parent/Guardian Information

Caseworker/Child Placement Agency Information