2025 Camp TrUSt! Camper Application
Name of Child
*
First Name
Last Name
Preferred Name for Name Tag at Camp
*
Gender
*
Please Select
Male
Female
Other
If you marked "other," please explain.
Child's Birthday
*
-
Month
-
Day
Year
Date
Child's Current Age
*
Child's Primary Language
*
Please Select
English
Spanish
Other
Child's T-shirt Size
*
Please Select
Adult Extra Small
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Caregiver's Name
*
First Name
Last Name
Relationship to Child
*
Caregiver's Primary Language
*
Please Select
English
Language
Other
Caregiver's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Caregiver's Phone Number
*
Please enter a valid phone number.
Caregiver's Email Address
*
example@example.com
Is your child assigned to a social worker?
*
Please Select
Yes
No
Caseworker Information
If you answered "yes" to the previous question, please fill out their caseworker's information.
Caseworker's Name
First Name
Last Name
Caseworker's Daytime Phone Number
Please enter a valid phone number.
Caseworker's Cell Phone Number
Please enter a valid phone number.
Caseworker's Email
example@example.com
DCFS/Foster Care Agency
Camper Information
Please fill this out honestly. This information will help us best serve your teen's needs. Please note that behavior questions are to help us gain a better understanding of your teen. The purpose is not to disqualify their ability to attend camp, but it will be used to match them with their counselor and tailor activities as needed.
Has your child attended Royal Family Kids Camp or Camp TrUSt before?
*
Please Select
Yes
No
Names, if any, of other siblings applying to this camp (teen camp):
What are the two most important things we should know about your child?
*
Explain any unusual family circumstances that make camp especially important for this camper (for example: recent crisis, being moved in foster placement, economic hardship, severe neglect, etc.)
*
Has your child moved homes while in foster care?
*
Yes
No
If so, how many times has your child been moved?
What method(s) of connecting, correcting, and empowering works well with this child?
*
Does your child have a personal Bible at home?
*
Yes
No
How often does your child display the following behaviors?
*
Often
Sometimes
Not At All
Agressiveness
Sexual Acting Out
Runs Away
Biting
Eating Disorder
Hyperactive
Learning Disabilities
Lying
Nightmares
Night Terrors
Stealing
Tantrums
Withdrawn
Bedwetting
Please elaborate on any of these selections above:
*
Please explain how the behaviors mentioned above present themselves at school:
*
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Medications
I hereby give the camp's Registered Nurses permission to administer the following products according to manufacturer's instructions, or as otherwise specified. I trust the camp's Registered Nurses to use his/her best judgment as situations arise and, if in doubt, can call for verification. Please select Yes or No for each over-the-counter medication listed below.
*
Yes
No
Sun block
Insect repellent
Band-aids
Antiseptic ointment
Antiseptic wash
Anti-itch cream
Cough syrup
Decongestant
Antihistamine
Upset stomach medication
Acetaminophen (Tylenol)
Ibuprofen (Motrin)
Cough drops
Please type your name below as authorization for the camp's nurse to administer the above indicated over-the-counter medication(s) during 7/31/3035 to 8/3/2025 (girls' camp) OR 8/7/2025 to 8/10/2025 (boys' camp).
*
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
Date
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Prescription 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.
Please list any prescription medications.
Name of medication
Purpose
Dosage
When is it taken?
1
2
3
4
5
Please type your name below as authorization for the camp's nurse to administer the above indicated prescription medication(s) during 7/31/2025 to 8/3/2025 (girls' camp) OR 8/7/2025 to 8/10/2025 (boys' camp).
Name
*
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
Date
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Medical History
Please indicate all known allergies, illnesses, and/or physical limitations.
Allergies to any food or medications? If yes, please describe the reaction, and if none, type "none".
*
Does your child have seasonal allergies?
*
Yes
No
Breathing problems (if none, type "none").
*
Any illnesses and/or hospitalization for medical or psychiatric reasons? If yes, please explain. If none, type "none".
*
Does this child use assistive devices such as a hearing aid, leg/arm brace, etc.? If so, please explain. If not, please type "none".
*
Doctor's Name
*
First Name
Last Name
Doctor's Phone Number
*
Please enter a valid phone number.
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To be signed at Registration at Nurses' Station on July 31st (girls) or August 7th (boys)
Printed Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
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Emergency Information
This information will only be used if there is an emergency.
Emergency Contact Name (primary person to be notified in case of emergency)
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Emergency Contact's Relationship to Child
*
Emergency Contact Name (additional secondary contact not required):
First Name
Last Name
Emergency Contact Phone Number (additional secondary contact not required)
First Name
Last Name
Emergency Contact's Relationship (additional secondary contact not required)
Name of Person Authorized to Pick Up Child
*
First Name
Last Name
Phone Number of Person Authorized to Pick Up Child
*
Please enter a valid phone number.
Name of Person Authorized to Pick Up Child (additional person not required)
First Name
Last Name
Phone Number of Person Authorized to Pick Up Child (additional person not required)
Please enter a valid phone number.
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Consent to Travel
This information should be shared with the child's caseworker and you should receive approval from the agency.
Child to travel with our camp, leaving from and returning to Mission Church, 82 Stratford Dr., Bloomingdale, Il (traveling by bus to Walcamp, 32653 Five Points Road, Kingston, Il 60145). The duration of the trip is July 31-August 3, 2025 (girls) OR August 7-10, 2025 (boys). As legal guardian per the "Normalcy Parenting and the Reasonable and Prudent Parent Standard" I give my child consent to travel to camp. By typing your name below, you are also agreeing that you will get the required approval from your child's caseworker for your child to travel if needed.
Caregiver's Name
*
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
Date
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Acknowledgement of Risk and Assumption of of Responsibility / Liability Waiver / Hold Harmless
I understand that I may participate in activities in Walcamp programs, which include: Archery, Boating, Swimming, Ziplining, Rock Wall Climbing, or other Activities. As a participant engaged in such activities always by my own choice, I assume the risk of injury. I understand the program has taken precautions to provide proper organization, supervision, instruction, and equipment for each activity, however, it is impossible for the program to guarantee absolute safety. Also, I understand that I share responsibility for safety.
Child's Name
*
First Name
Last Name
Caregiver's Name
*
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
Date
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Verification
By submitting this document and signing below, I certify that the above information is true and correct to the best of my knowledge.
Signature
*
Caregiver's Name
*
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
Date
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