Camper Registration: Royal Family KIDS Camp June 24 - June 28, 2024
This application enables you to register your child for the Northern Utah Royal Family KIDS 2024 Camp, Monday, June 24 thru Friday, June 28. The form asks information about the child's medical information, emotional/behavioral disorders, family history, questions for the safety and security of the child, specific child characteristics such as favorite color or likes/dislikes so that we can better help your child have a fun-filled week. All information is confidential. This information also helps us place your child with the most appropriate counselor/mentor for the week. A small head photo of the child (.jpg or similar) will need to be uploaded on the application. Please fill out ONE APPLICATION FOR EACH CHILD. Foster children who have graduated kindergarten through the 6th grade, as of June 2024, are eligible to attend (usually 6-12 years old). Kids who have been adopted are allowed to attend camp, however kids who have not been adopted and/or returning are first priority when being accepted to camp. Children in any Utah kinship placement programs are also eligible to attend Camp. This application does not guarantee the child a spot at camp. You will be notified if the child has been guaranteed a spot at Camp no later than May 15. If you have any questions please email email@example.com or call Sitka at 801-888-0002 or Pam at 801-725-8537.
Child's Preferred Name, if different from legal name:
Preferred First Name
Camp Date (Date Picker)
Date of Birth:
Age at time of camp:
Child's emotional age
Child's school grade level
Child's reading level
Child's T-shirt size
Child's shoe size (please specify if kids or adults size)
Child's pant size
Is the child a returning RFK camper?
If yes, please tell us what year(s) and what camp
Please upload a recent head shot color photo of this child (within the last six months). Upload a JPG, or PNG ONLY. You will not be able to upload a photo larger than 1 MB (or 1024 KB) in size.
Upload a File
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Choose a file
Pacific Islander or Native Hawaiian
Prefer not to answer
Child's home environment
Siblings of Child Applying to RFKC This Summer
If sibling(s) of this child will also be applying to this camp, please provide their info so we can try and get all siblings to camp this summer. PLEASE MAKE SURE AN INDIVIDUAL APPLICATION IS SUBMITTED FOR THE OTHER SIBLING(S)
Does the child have a sibling/relative who would like to attend this camp
If the child has siblings/relatives wanting to attend this camp, please tell us who they are.
Name of person filling out application:
Relationship of person doing app for child:
Phone Number of person doing app
Email of person doing app
Parent/Legal Guardian, same as person doing app
Parent/Legal Guardian Name:
Relationship of parent/legal guardian to child:
Phone Number of parent/legal guardian
Email of parent/legal guardian
Address of legal Guardian:
Street Address Line 2
State / Province
Postal / Zip Code
What date was the child placed in home:
How many foster or residential placements has the child had, including current home:
Emergency Contact, same as person doing app
Emergency Contact Phone #
Emergency Contact email
Authorized adult to pick child up at Elevation Church at 375 South State St., Clearfield, Utah
Pick up time is 1:00pm Friday, June 28th 2024
Authorized adults that will be picking the child up will need to show photo Government ID*
Caseworker/Child Placement Agency Information
Child's placement/caseworker agency name:
Child's placement/caseworker name:
Child's placement/caseworker phone #
Child placement/caseworker email
CASA (Court Appointed Special Advocate) name, if the child has one
CASA Phone #
Please fill this out to the best of your ability. We, as RFKC staff, want to make sure your child has a safe, healthy, fun time at camp. This information is extremely helpful!
Please tell us about this child's history or story. What situations may have been challenging for this child before living in your home? How long and why was this child placed in foster care? What circumstances is this child currently dealing with?
We expect and look for great things in each and every child. We also know that many of these children have had difficulties in their past which have shaped their present reality. Please give some information about his or her past so we can better understand this child.
Why would this child's attendance at RFKC be important? Why would you like to see him or her attend camp?
How often does the child have nightmares?
Rarely has nightmares
Frequently has nightmares
Always has nightmares
Any sleeping concerns? Does the child have difficulty falling asleep? Has the child slept away from home before? Please explain what may trigger the nightmares and what helps the child fall asleep.
How often does the child wet the bed?
Never wets the bed
Rarely wets the bed
Frequently wets the bed
Wets the bed every night
Wears a pull-up at night time
How good of a swimmer is the child (check all that apply)?
Not a good swimmer at all
Needs assistance of a floating device
Somewhat of a good swimmer
Is a great swimmer
Has to stay in shallow waters
Does the child display aggressive behavior?
Please explain more about the aggressive behavior? Please explain what may trigger the behavior or to whom the child is aggressive to and what helps when this behavior is displayed.
Does the child bite other children or adults?
Never bites others
Rarely bites others
Frequently bites others
Always bites others
Please explain what triggers the child to bite?
Does the child have any eating disorders or issues around food (check all that apply)
Hording or Stealing food
No eating disorders
Please tell us what triggers the eating disorder?
Please explain what may trigger the eating disorder and what may help it.
Does the child have any stool issues or conditions?
How would you describe the child's hyperactivity(check all that apply)?
Trouble paying attention
Moves about constantly
Takes meds to calm him/her
Please tell us more about the child's hyperactivity. What makes the child hyper or fidgety and what helps this behavior?
How would you describe the child's attention span?
Terrific attention span
Sometimes needs redirecting
Attention constantly needs redirecting
Very short attention span
Please let us know if there are any learning difficulties:
ie: Hearing impairment, Vision impairment, Dyslexia or reading difficulties. If there are any learning difficulties that will affect this camper's week or if there is information that would help us make camp better for your child please explain.
How often does the child lie?
Can't tell lies from the truth
Please explain what cause the child to lie and what recommendations would you use when this happens?
Please let us know how often this child runs away from a situation or from home?
Never runs away
Rarely runs away
Frequently runs away
Always runs away
Please let us know what situations may cause the child to run away?
Please let us know if -or how- the child may act out sexually?
Does not act out sexually
Touches other children
Makes inappropriate sexual comments
Flirts or pays inappropriate attention to others
Has sexual history
Please explain any sexual history and what may trigger the acting out.
Please explain what may trigger this behavior and what helps in managing it.
How often does this child steal things?
ie: Never steals, Rarely steals, Frequently steals, Always steals, Know of stealing in the past, but not currently
How often does the child have tantrums or anger issues?
Does not have tantrums or anger issues
Rarely has tantrums or anger issues
Frequently has tantrums or anger issues
Always has tantrums or anger issues
What are potential "triggers" for the tantrums or anger? Please describe what an overwhelming anger issue might look like. Please describe possible alternatives to help calm the child.
How often does this child withdraw? What may trigger this behavior? What helps the child to not withdraw?
How does this child rate on the Autistic scale:
Does not have signs of autisim
Explain the child's communication skills:
ie: Great listener, very expressive, likes to talk a lot, very quiet, communication difficulties, lack of interest in other people, lack of eye contact, difficulty in understanding other people's feelings and expressing their own, limited response to social interaction
Any additional behavior information you feel our staff or counselors need to know while your child is at camp? Please share anything that might be helpful!
Check all the boxes that are true about the child.
Does the child create a lot of noise?
Does the child crave bright lights, colors or busy pictures?
Does the child like to crash and bump into people, walls, etc.?
Does the child use a lot of force when touching, hugging, or with high fives?
Does the child stomp feet when walking or kick feet when sitting?
Does the child like to be under heavy blankets to sleep?
Does the child love to spin or swing?
Does the child like to hang upside down?
Is the child unaware of messiness on hands or face?
Does the child like to get dirty?
Does the child like bare feet?
Does the child dislike heavy backpacks or heavy blankets?
Does the child become very upset when bumped or pushed, even by accident?
Does the child dislike spinning or doing sumersaults?
Does the child get dizzy easily?
Does the child dislike being upside down?
Does the child dislike being picked up or moved?
Does the child dislike when his/her feet leave the ground?
Does the child dislike tags in clothing, seams in socks, etc.?
Is the child sensitive to certain types of fabrics in clothing and/or sheets?
None of these apply
Is the child sensitive to loud noises?
Medical History + Medication Information
Physicians Phone #
Child's medicaid/insurance number
Is the child current on vaccinations?
Please explain if the child is not current on vaccinations.
Illnesses and Medical Complications Past or Present (check all that apply)
Topical Allergies (lotion, sunscreen, etc.)
Dizzy Spells and/or Fainting
ADD or ADHD
Heart or Circulation Problems
Poison Oak/Poison Ivy Allergies
Type 1 Diabetes (previously insulin-dependent)
Type 2 Diabetes (previously non-insulin dependent)
Insect Bite Allergies (i.e. mosquitoes, bees, wasps, etc.)
Recent Broken Bones
List all known allergies to food, plants, medications, animals, etc.
Please explain and include any and all additional medical issues we should be aware of.
Please check YES or NO giving us approval to administer the medications listed below. This form must be completely filled out by the primary caregiver who signs below, or camper may not attend camp.
Acetaminophen (Tylenol) 325mg tabs
Acetaminophen Liquid (Tylenol) 160mg/5ml
Ibuprofen (Advil) 200mg tabs
Ibuprofen Liquid (Advil) 100mg/5ml
Diphenhydramine (Benadryl) 25mg tabs
Diphenhydramine Liquid (Benadryl) 12.5mg/5ml
Dextromethorphan (Delsym) 15mg/5ml
Calcium carbonate chewable (TUMS)
Cough Drops (generic)
Phenol spray (Chloraseptic spray)]
Triple antibiotic ointment (neosporin)
Hydrocortisone cream 1%
Hydrogen Peroxide OTC
Immodium (anti diarrhea)
Pepto Bismal liquid and chewables (anti nausea)
Calamine or Caladryl Lotion
Bactine (first aid/antiseptic/pain reliever)
Will your child be bringing Prescription and/or Over-the-Counter Medications?
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. I authorize RFKC medical staff to administer the medications. IMPORTANT: All Medications must be in original container with pharmacy or over the counter label on it. DO NOT pack medication in luggage, you will turn it into the nurse at registration.
Yes, I understand it is my responsibility to supply clear instructions and medical dosage needed and agree for RFKC medical staff to adminster the medications.
Please list ALL prescription and/or over-the-counter medications the child will be bringing to camp.
Any additional information we need to know about any prescription drugs, vitamins, or over-the-counter medications sent to camp - or - additional meds if any.
ie: Epi pen, Melatonin, sunscreen, bug spray, etc.
What specific activities should we ENCOURAGE your child to do while at camp?
What specific activities should be DISCOURAGED while at camp?
Please tell us what this child's interests, passions, and loves are so our Staff can make camp even more special. What are their strengths, positive traits, and characteristics (i.e. loves sports, crafts, favorite food, favorite color, favorite animals...whatever!)
At camp, we have a ratio of 2 campers of similar age paired together with 1 counselor/mentor. Will this scenario work well for the child?
Please explain what additional support your child may need?
How did you hear about Royal Family KIDS Camp
Stay Connected through our Mentoring Club
Mentoring Club is designed for any child that has attended Royal Family KIDS Camp
Throughout the school year campers and their mentors attend a once a month mentoring club meeting. Mentoring club is a place where a camper can reconnect with many of the participating staff members from camp, as well as build lasting friendships with the other mentoring club kids. Club KIDS enjoy the same songs, games, and friends they met at camp, which reinforces stability and character strength in their lives. Are you interested in finding out how this child can be part of the Mentors Program throughout the 2024-2025 school year?
Yes - Please register the child for mentoring.
Maybe - Please send me more information!
No, thank you
Authorized Signature: I have read the above "Permission to travel, waiver and release of liability" in the Terms & Conditions and by signing below I agree. It is my intention to exempt and relieve Elevation Church, For The Children, and Royal Family KIDS Camp leadership from all and any liability. Sign by using your mouse pad or touch screen.
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