2026 CAMPER APPLICATION

Royal Family Kids Camp, Bakersfield Ca #24

Camper Application 2026

Camp dates: June 8th - 12th

Please fill out this form in its entirety
2026 CAMPER APPLICATION
YesNo
If Yes - What County was the camp in?
Child First & Last Name*

First NameLast Name
Nick Name(s)
Child's Date of Birth*
Month - Day- Year
Current Age*
Current Emotional Age
MaleFemale
School*
2025-2026 Grade*
Child Medium (8/10)Child Large (12/14)Adult SmallAdult MediumAdult Large
Foster ParentGroup HomerelativeLegal GuardianAdoptive ParentBirth Parent
Name(s) of Parent Guardian*
Street address*

Street Address

Street Address Line 2

CityState / Province

Zip Code
Mailing address

Street Address

Street Address Line 2

CityState / Province

Zip Code
Cell Phone#1*
Format: (000) 000-0000.
Cell Phone #2
Format: (000) 000-0000.
Work Phone*
Format: (000) 000-0000.
Email*
example@example.com
AMPM
Emergency Contact*
Relation to Child*
Emergency Contact Phone*
Format: (000) 000-0000.
Alt Emergency Phone
Format: (000) 000-0000.
Kern County Social Worker*
Kern County Social Worker's Phone #*
Format: (000) 000-0000.
Kern County Social Worker email*
example@example.com
Foster Agency Social Worker*
Worker's Phone #*
Format: (000) 000-0000.
Foster Agency Social Worker EMAIL*
example@example.com
Social Services Agency*
Name of Other Agency
CAMPER DETAILS

Camper's Emotional/Behavior History*

Rows	Often	Sometimes	Not At All
Aggressiveness
Bedwetting
Eating Disorder
Hyperactive
Sensory Sensitivities
Lying
Night Terrors
Nightmares
Sexual Acting
Steals
Tantrums
Withdrawn

Please offer specific details that could assist us with campers week
GoodPoorUnknown
YesNo
List learning disabilities
Reading Level*
Number of times moved in Foster Placement
Explain any unusual family circumstances that make camp especially important for the child
Does the Child have a hard time transitioning from one activity to another If so what kind of responses/reactions can be expected*
Does the child have any Sensory Needs *
What are some triggers that may provoke this child to have negative behavior*
What actions can we take to help regulate the child's behavior*
Any specific activities to be encouraged?*
Any specific activities to be restricted and why?*
Please add any additional information you feel may be helpful to ensure your child has a great camp experience*
Medical/Health History
Childs Medical #
Health Insurance Co Policy #
Food, Seasonal, or other allergies*
Dietary Restrictions *
Illness/medical complications (explain in diagnosis symptoms if applicable)*
List any disabilities and or limitations*
Respiratory ProblemsHypoglycemiaHeart/CirculationMusculoskeletal AllergiesDizzy spellsSickle CellPulmonary EdemaBack PainSeizure DisorderAnaphylactic ShockBalance ProblemsDiabetesFaintingVision ImpairmentsHearing Impairments
List any details of the conditions checked*
PRESCRIPTION MEDICATIONS:

**All medication sent to camp must be in original container with the pharmacy label on it.
YesNo
Medication #1 Name*
Medication Name
Medication #1 Dosage*
Dosage
Medication #1 Time*
Time
Medication #2 Name*
Medication Name
Medication #2 Dosage*
Dosage
Medication #2 Time*
Time
Medication #3 Name*
Medication Name
Medication #3 Dosage*
Dosage
Medication #3 Time*
Time
Reason for Medications*
Primary Doctors Name*
Phone*
Format: (000) 000-0000.
Permission to addminister Prescription medications

(if applicable)

I understand that it is my responsibility as a caregiver to make sure of the following: all instructions are clear, the necessary dosage is adequately supplied for the duration of camp (8-12 June 2026) and each medication is in its original container. I hereby give the Royal Family Kids’ Camp Licensed Registered Nurse permission to administer the child’s medication as instructed on page 3 and will notify the nurse of any changes in medication, dosages, etc the day of registration.

I have read and acknowledge the statement above. By signing, I hearby athorize Royal Family Kids Camp #24 to administer perscription medications, if applicable.
Foster Parent Legal Guardian Signature*
Print Name*
Date application Signed*
Month- Day- Year
PERMISSION TO ADMINISTER OVER-THE-COUNTER MEDICATIONS.

I hereby give the Royal Family Kids' Camp Licensed Registered Nurse permission to administer the child's medication as instructed on page 3 and will notify the nurse of any changes in medication, dosages, etc the day of registration. The nurse is authorized to administer the following products according to manufacturer's instructions, or as otherwise specified. I trust the RFKC Licensed Registered Nurse to use her best judgment as situations arise, and if in doubt, he/she can call for verification.

Please check YES or NO for the medications listed below This form must be completely filled out by the primary caregiver (who signs below), or camper may not attend camp.

Medication*

Rows	Yes	No
Sunblock
Insect repellant
Lip balm
Rash ointment
Acetaminophen
Antiseptic ointment
Band-aid
Anti itch cream
Hydrogen Peroxide
Cough syrup
Decongestant
Antihistamine
Triple Antibiotic Cream
Tums
Lice treatment
Baking Soda (for splinters)
Latex Gloves (allergy?)
cough drops

If a child may NOT be given a product or is allergic to a known product please specify below*
MEDICAL RELEASE FORM:
This health history is correct, to the best of my knowledge, and the above named minor has permission to engage in all prescribed program activities, except as notated. The undersigned do hereby authorize the directors of Royal Family Kids Camp or such substitute, as they may designate, as agent for the undersigned to consent to an X-Ray examination, anesthetic, medical, dental or surgical diagnosis or treatment and hospital care for the above minor which is 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 or dentist, 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.
THE FOLLOWING SIGNATURE IS REQUIRED BEFORE THE APPLICATION WILL BE ACCEPTED:
I give permission for First & Last name* to attend Royal Family Kids Camp 2026
Foster ParentLegal Guardian Signature*
Print Name*
Date Application Signed*
Should be Empty:

2026 CAMPER APPLICATION

CAMPER DETAILS

Medical/Health History

MEDICAL RELEASE FORM:

THE FOLLOWING SIGNATURE IS REQUIRED BEFORE THE APPLICATION WILL BE ACCEPTED: