Child Application 2025

Child Application

Camp Dates: June 16 To June 20, 2025
NOTE: Many fields require an entry, if the field does not apply, enter "DNA".

("DNA": Does Not Apply)
Person Completing Application*

First NameLast Name
Relationship to Child*

CaseworkerFoster PatrentAdoptive ParentBiological ParentRelativeOther
Incarcerated Parent(s)?

NoneOneBoth
Child's Information
Child's Name*

First NameLast Name
Preferred Name?*
This name will be used at camp.
Is child a returning RFK camper*

Yes, returning RFK camperNo, not a returning RFK CamperDon't know if child has been to RFK camp before
If returning but had a DIFFERENT NAME

First NameLast Name
Gender assigned at birth*

MaleFemale
Birthdate*

MonthDayYear
Child's grade fall of 2025.*

1st. Grade2nd. Grade3rd. Grade4th. Grade5th. Grade6th. GradeOther
Emotional Age*

56789101112
Child's T - Shirt Size*

Child-SChild-MChild-LAdult-SAdult-MAdult-LAdult-XLAdult-XXL
Interest in Mentoring Club: 2025-2026 School Year?
Mentoring Club?*

Yes - send information!Maybe - send informationNo, thank you
Parent/Guardian Information
Best home description?*

Adoptive ParentsBiological Parent(s)Foster HomeGroup HomeRelativeResidential TreatmentUnaccompanied Refugee MinorOther
Approximate date of placement in current home?*

MonthDayYear
If applicable: Date of Adoption

MonthDayYear
Number of placements for the child including current home
Number of placements*
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Parents or Legal Guardians

Person(s) with whom child resides
Parent/Guardian #1
P/G #1 Name*

First NameLast Name
Relationship to Camper*
P/G Phone #1*

Area CodePhone Number
E-mail #1*
example@example.com (All camp information will be sent to this email address.
Parent/Guardian #2
P/G #2 Name

First NameLast Name
Relationship to Camper
P/G Phone #2

Area CodePhone Number
P/G E-mail #2
Case Worker/Child Placement Agency Information
Child Placement Agency(Current or Past if child has been Adopted)*
Caseworker Name*

First NameLast Name
Caseworker E-mail
Caseworker Phone Number*

Area CodePhone Number
Background/Behavior Information

Please fill this out to best of your ability. We as RFK staff want to make sure your child has a safe, healthy, fun time at camp. This information is extremely helpful!
Why attendance at RFKC be important?

Why would you like to see him or her attend camp?
Importants?*
Encouraged camp activities*
Swimming ability?*

Poor swimmerGood swimmerExcellent swimmerDon't know swimming ability
Bed Wetting
Bed wetting?*

Never wets the bedRarely wets the bedFrequently wets the bedWets the bed every nightDo not know about bedwetting
Bed wetting minimizing strategies*
Aggressive behavior?*

Never aggressiveRarely aggressiveFrequently aggressiveAlways aggressiveDo not know if child is aggressive
Describe behaviors and triggers.*
Eating disorders?*

AnorexiaBulimiaOvereating/GorgingNo eating disordersDo not know of any eating disordersHolding or stealing foodOther
Explain food issues*
Hyperactivity?*

Very calmSomewhat HyperactiveFrequently HyperactiveAlways HyperactiveDon't know about Hyperactive
Attention span?*

Terrific attention spanAttention constantly needs redirectingVery short attention spanDo not know about attention span yet
Learning difficulties?*

Hearing impairmentVision impairmentDyslexia or reading difficultiesDon't know about learning difficultiesOther
Suggestions to improve camper experience related to learning disabilities.*
lying?*

Never liesRarely liesFrequently liesAlways liesCan't tell lies from the truthDon't know if this child has a habit of lying
Triggers for lying?*
Night TERRORS.*

No night terrorsRarely has night terrorsFrequently has night terrorsDon't yet know about night terrors
Prevention/Calming night terror strategies?*
Nightmares*

No nightmaresRarely has nightmaresFrequently has nightmaresDon't know about nightmares
Prevention/Calming nightmare strategies?*
Running away?*

Never runs awayRarely runs awayFrequently runs awayAlways runs awayDon't yet know if child runs away
Runaway triggers and calming strategies?*
Sexually acting out?*

Does not act out sexuallyDo not know if sexually acts outTouches selfTouches other childFlirts or pays inappropriate attention to adults
If child acts out sexually, explain.*
Stealing?*

Never stealsRarely stealsFrequently stealsDon't know about stealing yetKnow of stealing in past, but not currently
If child steals, explain*
TANTRUMS or ANGER issues?*

No tantrums or anger issuesRarely has tantrums or anger issuesFrequently has tantrums or anger issuesDon't know about tantrums or anger yet
Strategies to redirect or prevent outbursts*
Withdrawn?*

Never withdrawnRarely withdrawnFrequently withdrawnDon't know about how often child withdraws yet
Explain triggers for becoming withdrawn: *
HISTORY/STORY: Please share this child's history or story so we can undrstand how to give him or her an even MORE amazing week at camp!
History

**Please tell us about this child's history or story. What situations may have been challenging for this child before living in your home? What circumstances is this child dealing with?
History Story*
RFK experience

If this child attended Royal Family KIDS" Camp in the past, what did he or she like about it? What positive changes or behaviors did you see upon their return home?
RFK Story*
Child's character strengths?*
Child's interests?*
Additional information to help at camp?*
MEDICAL HISTORY + PRESCRIPTION MEDICATION INFORMATION.
List all known allergies to FOOD, PLANTS, MEDICATIONS, animals, etc.*
Date of Last Physical*

MonthDayYear
Illnesses and Medical Complications Past or Present ( check all that apply)*

AAD or ADHDAllergies: Insect Bite (i.e. mosquitoes, bees, wasps, etc.)Allergies: MedicineAllergies: MusculoskeletalAllergies: Topical ( lotion, sunscreen, etc.)Anaphylactic shockAsthmaBack problemsBalance ProblemsBroken Bones (Recent)Diabetes-Type oneDiabetes-Type twoDizzy spells and/or faintingFood AllergiesFoot problemsHay FeverHeart or Circulation problemsHYPOGLYCEMIAPoison Oak/Poison Ivy AllergiesPulmonary EdemaRespiratory ProblemsSeizure DisordersSurgery (Recent)Other
Explain medical issues. Or, " DOES NOT APPLY"*
Explain why no meds or, "DOES NOT APPLY"*
Specific activities should be discouraged for medical reasons while at camp?*
Prescription Medications

I understand that it is my responsibility as a caregiver to make sure that all medications are clear and that the necessary dosage is adequately supplied for the duration of camp (Monday June 16, 2025 to Friday 20 2025) I authorize RFKC medical staff to administer the medications.
Responsibility*

Yes, I understand that sharing medical info, medications, and dosages are my responsibility
Prescription or over the counter Medication #1*
#1: Reason for taking, DOSAGE, and time(s) of day to administer*
Prescription or over the counter Medication #2*
#2: Reason for taking, DOSAGE, and time(s) of day to administer*
Prescription or over the counter Medication #3
#3: Reason for taking, DOSAGE, and time(s) of day to administer*
Additional Medication Information

nformation we need to know about the above prescription drugs, Vitamins, or OVER THE COUNTER MEDICATIONS sent to camp - or additional meds if any.
Additional Information?*
Physician, PA, or NP for Child*

First NameLast Name
Phone Number for Physician, PA, or NP for Child*

Area CodePhone Number
In what medical system does the child participate*

AuroraAscensionFroedtertAspriusOther
Immunizations not up to date:

DTP SeriesDTP BoosterTetanus BoosterPolio OPV (Sabin)Measels Vaccine (Live)German MeaslesAll up to date
Health Insurance Provider*
Health Insurance Policy Number*
Health Insurance Group Number*
Please SUBMIT this form, then go back to the main menu, and select the REQUIRED CHILD PERMISSIONS FORM from the menu, click PRINT and fill out the form and mail to the address specified on the form
Should be Empty:

Child Application

NOTE: Many fields require an entry, if the field does not apply, enter "DNA".

Child's Information

Interest in Mentoring Club: 2025-2026 School Year?

Parent/Guardian Information

Number of placements for the child including current home

Parents or Legal Guardians

Parent/Guardian #1

Parent/Guardian #2

Case Worker/Child Placement Agency Information

Background/Behavior Information

Why attendance at RFKC be important?

Bed Wetting

History

RFK experience