Royal Family Kids Camp

Tulsa, OK Chapter

June 30 - July 4, 2025
Royal Family KIDS

Camps for Foster Children 7 - 11 Years Old
REGISTRATION FORM

Instructions: This form must be completely filled out. The information is vital to the health and well-being of the child. Your application will be returned to you if it is not completely filled in. Due to the nature of our camp, we may be unable to provide a positive camping experience for children who have severely limiting emotional, intellectual or physical disabilities. For questions regarding suitability, please contact the directors at (RFK.Camp@christianchapel.com.
Name*

First NamePreferred NameLast Name
Gender*
Birthdate*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age*
Current Emotional Age*
School*
Grade*
Reading Level*
The child is living with:*

Foster ParentGroup HomeRelativeAdoptive Parent
Adopted Date?*

MonthDayYear
Date
Names of parents the child is living with*
Cell Phone:*
Please enter a valid phone number.
Alternate Phone:*
Please enter a valid phone number.
Foster Parent Email Address*
example@example.com
Emergency Contact Information
Name*
Cell Phone*
Please enter a valid phone number.
Relationship to Child*
Social Worker Information
Is the child in DHS custody?*

YesNo
Social Worker Name*
Phone Number*
Please enter a valid phone number.
Social Worker Email*
example@example.com
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.)
CAMPERS EMOTIONAL/BEHAVIORAL HISTORY

	Often	Sometimes	Not at all
Aggressiveness
Bedwetting
Biting
Eating Disorder
Hyperactive
Learning & Disabilities
Lying
Night Terrors
Nightmares
Runs Away
Sexual Acting Out
Steals
Tantrums
Withdrawn

Details from above
Name

First NameLast Name
DOB

MonthDayYear
Date
CAMPER DETAILS:
This child's swimming ability is?*

GoodPoorDo Not Know
Learning Disabilities:*

YesNo
Details
Has the child attended a Royal Family Kids Camp before?*

YesNo
If yes, where?
Camper T-Shirt Size:*

Child SmallChild MediumChild LargeAdult SmallAdult MediumAdult Large
Does the child have siblings that is camp age (7-11 years old)?*

YesNo
If yes, list name & DOB of siblings*
Allergies
Illnesses/medical complications
Disabilities/Limitations
Leg or Arm BracesHearing AidsEating Disorder
Indicate any of the following medical complications:

Respiratory ProblemsHeart or CirculationPulmonary EdemaHay FeverBalance ProblemsInsect BitesHypoglycemiaDizzy SpellsBackAnaphylactic ShockDiabetesDrug AllergyMusculoskeletal AllergiesFootSeizure DisordersPoison OakFaintingOther
Other
Any specific activities to be encouraged
Any specific activities to be restricted
IMMUNIZATION HISTORY: Please email a copy of the CURRENT Immunization Record or Grant Permission to Access Immunization Records from Oklahoma State Immunization Information System (OSIIS).
I hereby authorize Oklahoma State Immunization Information Systems to release, for the above named minor, immunization records and information located within to Royal Family Kids Camp.*

YesNo, I will email a copy of the current Imunization Records
PRESCRIPTION MEDICATIONS:

All medication sent to camp must be in original container with the pharmacy label on it.
Is your child taking any medications?*

YesNo
Medication List
What is(are) the medication(s) for:*
Doctors Name*
Phone*
I understand that it is my responsibility as 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 RFK's Camp Nurse to administer the above medication from June 30 - July 4, 2025.
Printed Name*
Date*

MonthDayYear
Date
Foster Parent or Legal Guardian Signature*

Clear
Name

First NameLast Name
DOB

MonthDayYear
Date
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 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 First Name Last Name to attend Royal Family KIDS Camp in the summer of 2025 through Christian Chapel.
Printed Name of ParentLegal Guardian*
Date*

MonthDayYear
Date
ParentLegal Guardian Signature*

Clear
Childs Medicaid*
PERMISSION TO ADMINISTER OVER-THE-COUNTER MEDICATIONS

I hereby give the Royal Family KIDS' Camp Registered Nurse permission to administer the following products from 6/30/2025 to 7/4/2025, or as otherwise specified.

I trust the RFK Camp 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.

	Yes	No	Specify if desired:
Sunblock
Insect repellant
Lip balm
Rash ointment
Tylenol
Antiseptic ointment
Band-aids
Anti-itch cream
Hydrogen peroxide
Cough syrup
Cough drops
Decongestant
Antihistamine
Ipecac syrup
Swimmer's Ear Drops
Melatonin Gummies
Other
Other

Foster Parent or Legal Guardians Signature*

Clear
Printed Name*
Phone numbers*
PLEASE NO PHONES OR MONEY - THESE ITEMS ARE NOT NEEDED AT CAMP.
Should be Empty:

Tulsa, OK Chapter

Royal Family KIDS

Camps for Foster Children 7 - 11 Years Old

REGISTRATION FORM

Emergency Contact Information

Social Worker Information

CAMPERS EMOTIONAL/BEHAVIORAL HISTORY

CAMPER DETAILS:

PRESCRIPTION MEDICATIONS: