Child Application for Royal Family Kids/For The Children Cape Summer Camp

August 11-14, 2025 - Child Summer Camp Application

Sponsored by Discover Life Church, 254 S Silver Springs Rd, Cape Girardeau MO 63703
For Foster Kids ages 6-12 years
HOW TO APPLY - To have your child age 6-12 years considered for the ROYAL FAMILY KIDS (RFK) CAMP PROGRAM, please complete this application. You will be contacted by a camp representative after the completed application has been reviewed.
Is this child a returning RFK Camper?

First time attending RFK CampChild is a returning RFK camperUnknown if attended RFK camp previously
Previous camp attended:
Name or Location
Child's Name*

First NameLast Name
Preferred Name*
Sex*

BoyGirl
Birth date *

MonthDayYear
Age *
Current Emotional Age *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School*
Grade*
The child is living with: (Check one)*

Foster ParentGroup HomeRelative
Name(s) of person(s) the child is living with*

First NameLast Name
Additional name of adult person(s) the child is living with (if more then 1)

First NameLast Name
Phone*

Area CodePhone Number
Email*
example@example.com
Work Phone

Area CodePhone Number
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Relationship to Child*
If Child currently has a social worker, please give name and phone:
Moved in Foster Placement how many times?*
Explain any unusual family circumstances that make camp especially important for the child:(for example: recent crisis, being moved in foster placement, severe economic needs, etc.)

MEDICAL RELEASE FORM
The above health history information 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 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. I give my permission for the above named child to attend Royal Family Kids Camp this summer.

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 hereby authorize RFKC’s nurse to administer the above medication from August 11, 2025 to August 14, 2025.
Child's Medicaid #*
Authorized Signature*

Clear
Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
Relationship to Child*
I understand, once my child has been approved, I will receive Over-the-Counter Medication and Participant Release of Liability Authorization Forms.

These forms must be completed before my child will be allowed to attend camp.
Authorized Signature*
Parent or Legal Guardian's Name*

First NameLast Name
Relationship to child:*
Phone Number*

Area CodePhone Number
Person Authorized to pick up child*

First NameLast Name
PLEASE NO CAMERAS OR MONEY. THESE ITEMS ARE NOT NEEDED AT CAMP.
Do not close your Browser until you see "Thank You - we have received your form."
Should be Empty:

	Often	Sometimes	Not at all
Agressiveness
Bed Wetting
Biting
Eating Disorders
Hyperactive
Learning & Disabilities
Lying
Night Terrors
Nightmares
Runs Away
Sexual Acting Out
Steals
Tantrums
Withdrawn

	Yes
DTP Series & Booster
Typhoid
German Measles(Rubella)
Tetanus Booster
Measles Vaccine (live)
Mumps Vaccine (live)
Polio OPV (Sabin)
Tuberculin (TB) Test
Small Pox

August 11-14, 2025 - Child Summer Camp Application

For Foster Kids ages 6-12 years

MEDICAL RELEASE FORM