Camper Application 2025

2025 Camp Dates:

Monday July 28th – Friday August 1st, 2025

Camp is intended for children between the ages of 6 and 11 that are currently in, or have been in the foster care system. More details about our camp can be found on our website.

Complete all required fields of this application. When complete, click on the SUBMIT button at the end of the form. Following your form submission, you will receive an email confirmation and be directed to sign and submit the camp facility waiver.

What Happens Next?

As the camp date approaches you will receive an email with the following:

Reservation Confirmation
Camper Packing List
Detailed instructions for the following
Camper Packing List
Camper Check-in/Drop-off on Monday, July 29th
Camper Pick-up on Friday, August 2nd

If you have any questions do not hesitate to reach out to our placement coordinator, Randy German at rrgmrg@cox.net or by phone at 949-294-8526.
General Information

(please allow 15- 30 minutes to complete application)
Active or Dropped

Caregiver/Legal Guardian Information
Caregiver/Legal Guardian Name*

First NameLast Name
Caregiver Name
Caregiver Mobile Phone Number*
Caregiver Alternative Phone Number
Leave blank if there is no 2nd number
Caregiver Email Address

Confirmation EmailCaregiver email address
Primary Caregiver is:*

Birth Parent(s)Foster Parent(s)Adoptive Parent(s)Grandparent(s)Aunt or UncleGroup HomeSTRTPOther
Is the camper in a group home*
Name of Group Home*
Group Home/ STRTP Name
Backup Emergency Contact Name*

First NameLast Name
Backup Name
Backup Emergency Contact Number*
Agency Name*
Enter N/A if no active Social Worker
Social Worker Name*
Enter N/A if there is no Social Worker
Social Worker Phone Number
Social Worker Email

Confirmation EmailSocial Worker email address

Medical Authorization
Name of Parent or Legal Guardian Signing Release*

First NameLast Name
Relationship to Child*
Relationship to Child of Person Signing Medical Release
I understand that it is my responsibility as caregiver to make sure that all medication 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 prescription medications according to the manufacturer’s instructions, or as otherwise specified and the authorized over-the-counter medications from 7-29-24 through 8-2-24. 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. The health history that has been provided 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 does hereby authorize the directors of Royal Family KIDS Camp (RFKC), 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. Should my child develop signs or symptoms of COVID while at camp, I authorize them to be tested for COVID using a rapid test. I understand that if my child tests COVID positive while at camp, I will be contacted immediately by a member of the RFKC Leadership Team to make arrangements for the child’s safe transportation home. This authorization will remain effective while the above minor is en-route 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. (hold left mouse button down to sign)
Signature*

Clear
Date Signed

MonthDayYear

Child Pick-up Authorization
Person Authorized to Pick-up Child After Camp on Friday, August 2nd*

First NameLast Name
Pick-up Person
Pick-up Person's Relationship to Child*
Authorized Pick-up Person Phone Number*
Name of Parent/Legal Guardian Authorizing Pick-up Person *

First NameLast Name
Signature of Parent/Legal Guardian Authorizing the Pick-up Person Named Above*

Clear
Date SIgned

MonthDayYear
Date
Optional After-Camp Mentoring Program
Kids who have attended Royal Family Kids Camp can apply for the Royal Family Kids Mentoring Club. Mentoring Club will match an adult mentor with a camper for a minimum of 4 hours a month one on one time and a once-a-month group gathering. Mentoring Club begins in the fall and continues to the end of the school year. Approved Mentors can help with transportation and there is no fee for participation. Club participation is limited.

If you have any questions about the Mentoring Club you can contact the Mentoring Director:

Deneé Grauberger
rfkclubrockharbor@gmail.com
702-461-4934
I am interested in having my child participate in the Royal Family Kids Club & Mentoring program in 2024-25*

YesNoNot sure yet

After submitting this application you will receive an email confirmation and be redirected to the camp faility's liability waiver form. Please fill in the requested information on the waiver and submit. A signed waiver must be recieved in order to attend camp
Liability waiver signed

YesNo
Camp Name
Photo Link
Should be Empty:

	Not At All	Sometimes	Often
Night Terrors
Bed-wetting
Biting
Eating Disorder
Hyperactive
Learning Disability
Lying
Aggressiveness
Nightmares
Running Away
Sexual Acting Out
Stealing
Tantrums
Withdrawn

General Information

Camper Application 2025

Child Information

Caregiver/Legal Guardian Information

Child's Social History

Child's Medical History

Child's Prescription Drugs

Medical Authorization

Child Pick-up Authorization

Optional After-Camp Mentoring Program