Royal Family KIDS Camp Keiki Registration Form

Please DO NOT PRINT this application - it must be filled out and submitted online. It will take approximately 20 minutes to complete it. DEADLINE is June 1st. All keiki must be between the ages of 6-11 at the time of camp: July 14-18, 2025. Items marked with an * are mandatory. Campers must be active with CWS, both as an intake or through an intervention program (family supervision). Acceptance to the camp is on a First Come - First Served basis. To learn more about the camp, please visit: rfkmaui.org
All the information we collect are kept confidential for the purpose of the camp only. One form per child, please.

If you have questions or concerns about the camp, please contact our Chapter Director, Nestor Fontanilla at: keiki@royalfamilykidsmaui.org or 808-385-6789
Name of Person Filling Out this Application*

First NameLast Name
Relationship To Child*

Caregiver (RCG)GrandparentsUncle/AuntyBio ParentsOther, specify:
CHILD'S INFORMATION

Please fill out a form for EACH child. We need the details of each camper.
Child's Legal Name*

First NameLast Name
Preferred Nickname (If child has one. Otherwise, enter "None")*
Sex*

MaleFemale
Birthdate*

MonthDayYear
Age at Time of Camp (July 14-18, 2025)*

6 years old7 years old8 years old9 years old10 years old11 years old
Emotional Age *
This child will be entering this grade in the fall of 2025.*

1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade
Child's T-Shirt Size*

Child SChild MChild LAdult SAdult MAdult L
Is this child a returning RFK camper?*

YesNo, first time to attendDon't know if child has been to RFK Camp before
Are you interested in signing up your child in a Mentoring Program throughout the 2025-2026 school year?*

Yes - Please send more information!Maybe - Please send more information!No, thank you
Siblings of child applying to RFK Camp this Summer

If siblings of this child is/are attending the camp, please provide their name(s) below and fill up a SEPARATE form for each child. All campers must be in active care with Child Welfare Services.
If a sibling of this child is applying to camp, please tell us who that is.

First NameLast Name
This sibling is a...

Biological SiblingFoster SiblingSibling in Adoptive Family
If 2nd sibling is applying to camp, please tell us who that is.

First NameLast Name
2nd sibling is a...

Biological SiblingFoster SiblingSibling in Adoptive Family
If 3rd sibling is applying to camp, please tell us who that is.

First NameLast Name
3rd sibling is a...

Biological SiblingFoster SiblingSibling in Adoptive Family
RESOURCE CAREGIVER / GUARDIAN INFORMATION

(The main Point of Contact for the camper)
The home where the child is currently living is best described as ...*

Foster HomeAdoptive ParentsKinship/Bio SiblingBiological Parent(s)Other
How long has this child been living in current home?*

less than 1 month2-6 months7-12 months1-3 years4-6 years6+ yearsOther
If known, total number of residential placements of this child, including current home
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Foster parent or Guardian (this person will receive the email auto-reply and future email correspondence regarding the child) *

First NameLast Name
Relationship to Child*
Best Phone Number*
This phone is a:*

Cell PhoneWork PhoneHome Phone (land line)
Foster parent or Guardian Email Address*
example@example.com
Emergency Contact*

First NameLast Name
Relationship to Child
Emergency Phone Number*
This phone is a:

Cell PhoneWork PhoneHome Phone (land line)
CASEWORKER/GAL/CASA INFORMATION

(Please inform them that your foster keiki is attending the camp)
Caseworker's Name*

First NameLast Name
Caseworker's Cellphone Number*
Caseworker's Email*
example@example.com
Guardian Ad Litem's/CASA's Name

First NameLast Name
Cellphone number
Email
example@example.com
CAMPER'S EMOTIONAL/BEHAVIORAL INFORMATION

The information you provide on your foster child's history is CONFIDENTIAL. We want to make sure this child, as well as other campers, have a safe, healthy, fun time at camp. This information is shared with camp staff on a "need-to-know" basis only. This helps us determine how to best provide care and attention to the children.
What do you hope your child will gain for attending the camp?*
Does this child display aggressive behavior?*

NoRarelyAlwaysDo not know if child is aggressive
Please explain the aggressive behavior. (What may trigger behavior and what has worked to resolve or redirect the behavior.)
Does the child deal with any of the following eating disorders or issues around food?*

No Eating DisordersWe are not aware of any Eating DisodersAnorexia/BulimiaOvereating/Gorging
If this child does have an any issues around food, please explain.
How would you describe this child's demeanor?*

CalmSomewhat hyperactiveAlways hyperactive; monitored with medication. Please list in the Medication section.Don't know about hyperactivity
Please let us know if any of the following impairments or difficulties exist for this child. Please check all that applies*

Hearing impairmentVision impairmentReading difficultiesLearning difficultiesOther, please explain below
How often does this child withdraw?*

Not withdrawnFrequently withdrawnDon't know about how often child withdraws yet
Please let us know how often this child runs away from a situation or from home.*

Does not run awayFrequently runs awayDon't know yet if child runs away
Please let us know if - or how - this child may act out sexually.*

Does not act out sexuallyTouches other children inappropriatelyFlirts or acts out inappropriately with adultsDo not know if sexually acts out
If this child does act out sexually, please explain.
How often does this child have tantrums or anger issues?*

No tantrums or anger issuesFrequentlyDon't know about tantrums or anger yet.
If this child have tantrums or anger issues that are beyond normal childhood frustrations, please explain so we know how to redirect or prevent outbursts.
Has this child experienced a sudden trauma/loss within the last 3-6 months?

YESNO
If YES, Please briefly explain. We want to be sensitive to your child.
Any triggers or adverse reactions to a certain gender, noise, smell, food, activities, etc.? What techniques have you used successfully to deal with it?
Are you interested in a support group, camp, or retreat, etc. that deals specifically with grief, if it's available for your foster keiki?

YESNOMaybe, please provide more info.
HISTORY/STORY: Please share this child's history or story so we can understand how to give him or her an even MORE amazing week at camp!
** What situations may have been challenging for this child before living in your home? What circumstances is this child dealing with now?*
Please tell us what this child's interests, passions, loves, etc. so our Camp Staff can make camp even more special! (i.e. loves sports, interested in animals, favorite color ...whatever!)
This child's swimming ability is...*

Does not swimGoodExcellentTaking swimming lessons
MEDICAL HISTORY + Prescription Medication Information
List ALL known ALLERGIES to food, plants, medications, animals, etc. (If none, please enter "NONE")*
Illnesses and Medical Complications Past or Present (check all that apply)*

NONE/UNKNOWNRespiratory ProblemsDizzy Spells and/or FaintingBack ProblemsSeizure DisordersAnaphylactic ShockBalance ProblemsAsthmaADD or ADHDHypoglycemiaPulmonary EdemaRecent SurgeryDiabetesOther
Please explain each medical issue you checked above. (If you did not check anything, please enter "N/A."*
What, if any, specific activities should be DISCOURAGED for medical reasons while at camp?
NON-PRESCRIPTION Medications/Treatments: you APPROVE that our medical team can administer at camp.*

ALL OTC Meds listed belowSunblock/SunscreenInsect RepellentLip BalmRash OintmentHydrogen PeroxideTylenolCough DropsAntiseptic OintmentBand-aidsAnti-Itch CreamOther
Any other medical/health challenges that was not listed which may affect your child's participation with all the camp activities: games, sports, playground equipment, bicycling, etc.
PRESCRIPTION/OVER-THE-COUNTER MEDICATIONS

Please list any medications that your child will bring to camp. Please handover any Meds to the Camp Staff when you drop him/her off. We will secure them accordingly. WE PREFER ALL PRESCRIPTIONS ARE GIVEN IN THE ORIGINAL CONTAINER AND INSTRUCTIONS, BUT IF NOT, WE WILL ACCEPT DETAILED WRITTEN DIRECTIONS. Please LABEL the container with your child's name.
Is your child bringing Prescriptions/OTC with him/her to camp?*

YESNO
I understand that it is my responsibility as a caregiver to make sure that all instructions are clear and that the necessary dosage is adequately supplied for the duration of camp (July 14-18) I authorize RFK medical staff to administer the medications. Verbal instructions are not acceptable*

Yes, I understand that sharing medical info, medications, and dosages are my responsibility.
Prescription or OTC Medication #1
Medication 1: Reason for taking, DOSAGE, and TIME(s) of day to Administer
Prescription or OTC Medication #2
Medication 2: Reason for taking, DOSAGE, and TIME(s) of Day to Administer (Be specific.)
Prescription or OTC Medication #3
Medication 3: Reason for taking, DOSAGE, and TIME(s) of Day to Administer (Be specific.)
SIDE EFFECTS of ANY of the meds above sent to camp?
Additional information we need to know about the above prescription drugs, vitamins, or over-the-counter medications sent to camp - or - additional medications, if any.
Child's Primary Doctor*

First NameLast Name
Doctor's Phone Number*
Clinic where your child usually go to:
Child’s Medicaid # *
Any other Medical Insurance # (Enter "N/A" if there is none.)*
MEDICAL RELEASE:

This health history is correct so far as I know, and the above-named minor has permission to engage in all prescribed program activities, except as noted. The undersigned hereby authorizes the Staff of Royal Family Kids Camp or such substitute as they may designate as agent forthe undersigned to consent to an X-Ray examination, anesthetic, medical, dental,or surgical diagnosis or treatment and hospital care for the above minor whichis deemed advisable by and to be rendered under the general or special supervision of any physician and surgeon, licensed under the provision of the Medicine Practice Act or any dentist licensed under the Dental Practice Act, whether such diagnosis or treatment is rendered at the office of said physician ordentist, at a hospital, camp or elsewhere. This authorization will remain effective while the above minor is enroute to and from or involved or participating in any camp program unless revoked in writing by the undersigned and delivered to the Director of Royal Family as legal guardian/social worker/other.
PERMISSION and RELEASE TO TRANSPORT:

As the undersigned legal parent or caregiver, I hereby give my permission for my child(ren) to ride in any vehicle designated by the adult(s) in whose care my child(ren) has been entrusted while participating in the Royal Family KIDS Day Camp event on July 14-18, 2025. I acknowledge and agree to adhere to the designated drop-off and pick-up schedule (To Be Announced at a later date) at the specified location, considering the camp's timetable and other participants. This Transportation Permission & Release Form is effective on the date of my signature on this form and will remain in full force and effect as long as my child(ren) participates in the Royal Family KIDS Camp program in any manner. In consideration for permitting my child to be transported to and from the program, I do hereby release Royal Family KIDS Maui program, For The Children National Office, Chapter Director, leaders, volunteers, host church, and any designated driver of a van, bus, car, or other vehicle used in connection with any of the activities from any and all claims for injuries, losses, damages, costs and expenses that I, and/or my child, might have arising out of, or in any way relating to my child and I agree to hold the Released Parties harmless from any loss arising from such claims.
Person(s) Authorized to drop off/pick up my child*

First NameLast Name
Phone Number*
By my signature, I declare that I have provided all the information to the best of my knowledge and hold them to be true.

I give my permission for the minor named in this application to attend Royal Family KIDS Camp - Maui in the Summer of 2025.

I hereby reiterate my responsibility as the caregiver in regard to the Medical Release and Permission to Transport.
Name*

First NameLast Name
Relationship To Child*

Foster parent (RCG)Biological ParentOther (if other, please specify)
Signature

Clear
Date*

MonthDayYear
Upon completion of Camp Registration, I prefer to receive follow-up correspondence and last-minute instructions through:*

Text MessagingE-mail
Enter the message as it's shown*
Should be Empty:

All the information we collect are kept confidential for the purpose of the camp only. One form per child, please.

CHILD'S INFORMATION

Siblings of child applying to RFK Camp this Summer

RESOURCE CAREGIVER / GUARDIAN INFORMATION

CASEWORKER/GAL/CASA INFORMATION

CAMPER'S EMOTIONAL/BEHAVIORAL INFORMATION

HISTORY/STORY: Please share this child's history or story so we can understand how to give him or her an even MORE amazing week at camp!

MEDICAL HISTORY + Prescription Medication Information

PRESCRIPTION/OVER-THE-COUNTER MEDICATIONS

MEDICAL RELEASE:

PERMISSION and RELEASE TO TRANSPORT: