LCdC RFK Camp Summer 2025

History / Story

Please share this child's history or story so we can understand how to give him or her an even MORE amazing week at camp!
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? *
Please tell us what this child's interests, passions, loves, etc. are so our Staff can make camp even more special! (i.e. Loves sports, interested in horses, favorite color is purple...whatever!)*
Please tell us what this child's interests, passions, loves, etc. are so our Staff can make camp even more special! (i.e. Loves sports, interested in horses, favorite color is purple...whatever!)*

Prescription & Over-the-Counter Medications
If your child is NOT taking any prescription or over-the-counter medications, vitamins, or inhalers to camp, please type "NONE" in each of the boxes.
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 (Monday, June 3 - Friday, June 7, 2024). I authorize RFKC medical staff to administer the medications.*

Yes, I understand that sharing medical info, medications, and dosages are my responsibility.
Prescription or Over-the-Counter Medication #1*
Prescription Medication 1: Reason for taking, DOSAGE, and Time(s) of Day to Administer*
How long has child been taking Medication #1? (Be specific.)*
Prescription or Over-the-Counter Medication #2*
Medication 2: Reason for taking, DOSAGE, and Time(s) of Day to Administer (Be specific.)*
How long has child been taking Medication #2? (Be specific.)*
Prescription or Over-the-Counter Medication #3*
Medication 3: Reason for taking, DOSAGE, and Time(s) of Day to Administer (Be specific.)*
How long as child been taking Medication #3? (Be specific.)*
Type a question*
Additional information we need to know about the above prescription drugs, vitamins, or over-the-counter medications sent to camp - or - additional medications, if any.*
Primary Care Physician*

First NameLast Name
Doctor's office phone number*
Please enter a valid phone number.
Do you have any questions?

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 2024 through La Casa de Cristo, 6300 East Bell Road, Scottsdale, AZ 85254.
Name*

First NameLast Name
Date*

MonthDayYear
Date
PERMISSION TO TRANSPORT
The above-mentioned organizations, are hereby authorized to transport said minor by bus from the registration location in Scottsdale, AZ to the campground on Monday, June 3, 2024, and transport the minor from the campground to the pick-up location in Scottsdale, AZ on Friday, June 7, 2025. I understand that if I should, for any reason, desire to retrieve said minor from camp before Friday, June 7, 2024, I will first be required to make arrangements with the directors and meet at an agreed upon location.

I also give permission for the Royal Family representatives to transport said minor to the emergency room in case of an emergency. I know that I will be called immediately should this happen.

By my signature, I release La Casa de Cristo, Royal Family Kids inc, and any other involved parties from liability in relation to travel to and from camp.
Name*

First NameLast Name
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

LCdC Camper Registration Form 2025

June 2-6, 2025
All campers must be between 7 - 11 at the time of camp.

LCdC Camper Registration Form 2025

June 2-6, 2025All campers must be between 7 - 11 at the time of camp.

June 2-6, 2025
All campers must be between 7 - 11 at the time of camp.