RFK_Camper Application 2025

2025 ROYAL FAMILY KIDS CAMP

Camper applicant must be between the ages of 7-11 on June 2, 2025
QUESTIONS?

If you have questions or concerns about RFKC Ocala please contact our volunteer Child Placement Coordinator or Camp Director Tiffany Bagasan at director@sharetheloveocala.com

You will be contacted by our Child Placement Coordinator who will talk to you futher about this application once submitted.
Child's Name

First NameLast Name
If this is a NEW name because the child was adopted, what was the child's birth name?
Preferred Name
(the name we should call them at camp)
Is this child a returning RFK Camper?

Yes, returning OCALA RFK CamperYes, returning RFK Camper from other countyUnsure if child has been to RFK Camp
Please upload a picture of the child.

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Your Relationship to the Child
Birthdate

MonthDayYear
Age of Child on June 2, 2025

7891011
Biological Sex

MaleFemale
Child's Current Grade
Child's T-Shirt Size
Pant Size
Shoe Size
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?
SIBLINGS OF CHILD APPLYING TO RFK CAMP THIS SUMMER

If siblings of this child will ALSO be applying to come to camp, please provide their information so we can try to get all siblings to camp this summer. A separate registration will need to be completed for each child.
List the child's siblings' name and how they are related (Biological Sibling, Foster or Group Home Sibling, Sibling in Adoptive Family)
(ie Leah Davis - biological sibling, Jason Smith - foster sibling)
PARENT/GUARDIAN INFORMATION
This child lives with...
How long has this child lived in the current home?
# of foster/residential placements for child since removal
Parent/Guardian's Name

First NameLast Name
Parent/Guardian's Phone #
Please enter a valid phone number.
Permission to text camp information

Yes, you have my permission to textNo, please don't text
Parent/Guardian's Email Address
example@example.com
Home Mailing Address (for camp correspondence)

Street Address

Street Address Line 2

CityState

Zip Code
Name and Phone Number of a SECOND Authorized Adult
(in case we can't reach primary guardian)
AUTHORIZED TO PICK CHILD UP FROM CAMP
List ALL authorized adults that can pick up child from camp. Names and phone numbers:
CASEWORKER/CHILD PLACEMENT AGENCY INFORMATION
CASEWORKER Name / Phone Number
Caseworker Email Address
example@example.com
Does this child have an IEP in school? If so, please explain more.
If child is currently in foster care, what is the goal?

Reunify with parentsRelative careAdoptionOther
Please explain more about the permanency goal from what you know. Does this child have a prospective adoptive family waiting to adopt them?
BACKGROUND/BEHAVIOR INFORMATION

Please fill this out to the best of your ability. All information shared is confidential. We as RFKC staff want to make sure this child as well as other campers have a safe, healthy, fun time at camp. This information is extremely helpful and is only shared with camp staff on a "need to know" basis.
Type of abuse child has experienced (check all that apply)?

Physical AbuseNeglectSexual AbuseOther
Please tell us about this child's history or story. What events led to the child receiving involvement from Department of Children and Families (DCF) or removed from their home?
Child's ability to control their anger or aggression.
Is your child in an ESE classroom?
Does your child have an IEP with school?
Please upload the IEP here or submit pictures of the plan below.

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Are there any aversions, fears, or triggers that this child experiences due to
Does this child have an intellectual disability?
If yes, please explain more about this. Diagnosis? How does this play out in their lives, triggers, comforts, limitations?
Has this child been suspended from school for extreme behavior?
If yes, please explain more about this.
Does your chid have a behavioral management plan for the classroom?
Why do you want this child to attend camp?
Does the child deal with any of the following eating disorders or issues around food?

Anorexia / BulimiaOvereating / GorgingHoarding or Stealing FoodNo known eating disorders
Please explain more about food issues child may have.
Does child have food sensitivities that we need to know about?
ie. diabetic, gluten, peanut allergies
Does child struggle with high energy level?
Does child have difficulty telling the truth?
How often does this child run away from a situation or from home?
Please let us know if this child sexually acts out inappropriately. Choose all behaviors you have seen.

Not a concernTouches selfTouches other childrenInappropriate attention to peers or adultExposes themselves
If this child does act out sexually, please explain.
Child has displayed self harming behavior or suicidal thoughts or actions.

NoYes (explain below)
Please explain
How does this child deal with loud, party like envirnoments?
How does this child tend to interact with other children? Adults? Their siblings?
Please explain child's history and what led to them being removed from their how. If abused occurred, how long ago did it happen?
How long has this child been in their current home or placement? If there was a recent change in the placement what was the cause of that move?
What is this child's nighttime routine before bed?
How shy is this child?
Does the child take things that do not belong to them?

NoYes
CAMPER PERSONALITY: Share some strengths about this child (ie kind, optimistic, determined, athletic, friendly)
Please tell us what are this child's interests, passions and loves. (i.e. Loves sports, interested in horses, favorite color)
BIRTHDAY PARTY: We have a Birthday Party for the campers every year. Please list 3 gifts ideas in the $20 price range. No gift cards, electronics, games, clothing please. Be Specific (ie RC Cars, Nerf, Barbies, Legos, Baby Dolls, Art Kits, Nail Kits)

Remote Control CarNerf GunBarbiesLegosBaby DollsNail KitsArt/Craft KitsJewelry Making SuppliesTECH Decks (tiny skate boards)Pokemon Sets18 Inch Dolls
Specific Birthday Gift Ideas
Child's swimming ability
MEDICAL HISTORY + PRESCRIPTION MEDICATION INFORMATION
This child was in enrolled in public or private school this year.

YesNo (please upload immunization records below)
Attach a Copy of Child's Immunization Records (not required if child was enrolled into public or private school for this year)

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Child's Medical History (check all that apply)

Respiratory ProblemsSeasonal AllergiesFood AllergiesMedicine AllergiesTopical Allergies (lotion, sunscreen etc)Dizzy Spells and/or FaintingBack ProblemsSeizure DisordersAnaphylactic ShockBalance ProblemsAsthmaAutism / Autism Spectrum DisorderADD or ADHDHypoglycemiaHeart or Circulation ProblemsPulmonary EdemaType 1 DiabetesType 2 DiabetesInsect Bite Allergies (ie mosquitoes, bees etc)Recent SurgeryRecent Broken BonesHearing ImpairmentVision ImpairmentNone
Difficulty sleeping at night
Please explain any checked medical issue you checked above.
Sleeping - share what helps when child is having a hard time sleeping:
Does this child wet the bed at night?

NoSometimesYes
If child does wet the bed, please explain (i.e. wears pull-ups, don't drink liquids after certain time, just need to be aware, etc.). This is just so we know how to best care them at camp.
PERMISSION TO ADMINISTER

OVER-THE-COUNTER MEDICATIONS

I give Royal Family Kids Camp (A program of Share The Love Ocala) Registered Nurse permission to administer the following products according to manufacturer’s instructions, or/as otherwise specified. RFK Registered Nurse has permission to provide any of the following that is/are needed:

Sunblock
Insect Repellent
Lip Balm
Rash Ointment
Tylenol
Antiseptic Ointment
Band-Aids
Anti-Itch Cream
Hydrogen Peroxide
Cough Syrup
Cough Drops
Decongestant
Antihistamine
Ibuprofen
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.

Yes, to everything listed above.No (please list specifics below)
Please share list of specific medicines you do not wanted given to this child from the list above.
List ALL CURRENT Prescription Medication the child is on and the reason for taking, dosage and time of day taken
1. Claritin / Allergies / 1 pill in morning with food 2. Trazadone 50 MG / Bed Wetting / 1 pill before bed
PRESCRIPTION & OVER-THE-COUNTER MEDICATIONS

If your child is NOT taking any prescription or over-the-counter medications, vitamins, or inhalers to camp, please skip to the PRIMARY DOCTOR field.
Child's Primary Doctor
Please continue your child's medication through camp and do not make any medicine changes until after they return from camp

I have read the above and will be mindful of that request
MEDICAL PERMISSION:

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 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: X-Ray examination, anesthetic, medical, dental or surgical diagnosis or treatment and hospital care for the above minor, which 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 en-route to and from camp, 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. My permission is given for the minor named in this application to attend Royal Family KIDS Camp in the summer of 2025 through Share The Love Ocala.
Medical Permission Signature of Authorized Adult
First and Last Name
PERMISSION TO TRANSPORT:

The above-mentioned organizations, are hereby authorized to transport said minor by bus from the registration location in Ocala, FL to the campground on June 2nd, 2025, and transport the minor from the campground to the pick-up location in Ocala, FL on Friday, June 6th, 2025. I understand that if I should, for any reason, desire to retrieve said minor from camp before Friday, June 6th, 2025, I will first be required to make arrangements with the directors and meet at an agreed upon location. By my signature, I release Good News Church, Share The Love Ocala, Royal Family Kids Inc, and any other involved parties from liability in relation to travel to and from camp.
Permission to Transport Signature of Authorized Adult
First and Last Name
Waive, Release and Discharge:

In consideration of my application and permitting my child to participate in this activity, I hereby:

WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of Share The Love Ocala, its officers, employees, volunteers, entities or other persons released, for my child’s death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to them including their traveling to and from this activity;

INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE Share The Love Ocala, its officers, employees, volunteers, or other entities or persons released from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise.

I understand that while participating in this activity, my child may be photographed. I agree to allow their photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns.

The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. Share The Love Ocala, it’s directors, officers, and all its employees, and volunteers acting officially or otherwise are hereby released from any and all claims, demands, actions, or causes of action on account of any injury to my child that may occur. This release binds my heirs,
executors, administrators, and/or assigns.
I CERTIFY THAT I HAVE READ THIS DOCUMENT, FULLY UNDERSTAND ITS CONTENT, AND AGREE TO ITS TERMS. Signature of Authorized Adult
First and Last Name
Today's Date

MonthDayYear
Date
Should be Empty:

2025 ROYAL FAMILY KIDS CAMP

SIBLINGS OF CHILD APPLYING TO RFK CAMP THIS SUMMER

PARENT/GUARDIAN INFORMATION

AUTHORIZED TO PICK CHILD UP FROM CAMP

CASEWORKER/CHILD PLACEMENT AGENCY INFORMATION

BACKGROUND/BEHAVIOR INFORMATION

MEDICAL HISTORY + PRESCRIPTION MEDICATION INFORMATION

PRESCRIPTION & OVER-THE-COUNTER MEDICATIONS