RFK Camper Registration 2025

CAMPER APPLICATION
Royal Family KIDS Camp is a program of For The Children San Diego and sponsored by Park Hill Church.

There are multiple Royal Family KIDS Camps in San Diego County.

Please pay attention to the dates listed below to ensure you're signing up for the correct camp.

Camp Dates: June 30 - July 4, 2025

Ages: 7 - 11 Years

If you have questions or concerns about Royal Family KIDS Camp,

please contact Arielle Dortch at royalfamilysd@gmail.com

Camper spots are limited and filled on a first come, first served basis. All applications must be received by June 1, 2025.

Search Policy: For the success and safety of all camp attendees, it may be necessary to search a child’s bags or property to assure they have everything they need for a successful week (i.e. clothing, swimsuit, toiletries, etc.) and a safe week (i.e. no candy, electronics, tobacco products, or other inappropriate items.) Any illegal items will be turned over to proper authorities be that the Guardian, Social Worker or Law Enforcement and the Guardian will be informed. Any other items removed will be returned directly to the legal Guardian at registration, if possible, or at the end of the camp.
Please upload a recent photo of this child*

Cancelof
Child's Legal Name*

First NameLast Name
Preferred Name (printed on name tag)*
Biological Sex*

MaleFemale
Birthdate*

MonthDayYear
Date
Age at the time of camp*
Developmental Age*
Child's Shirt Size*

Child SmallAdult SmallChild MediumAdult MediumChild LargeAdult Large
Shoe Size*
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
This child's home would be best described as:*

Foster homeGroup homeAdoptive homeHome of relativeOther
Primary Guardian's Name*

First NameLast Name
Relationship to Child*
Email (all camp information will be sent to this email address)*
example@example.com
Phone Number*
Please enter a valid phone number.
Is there a second guardian that should be listed on this form?*

YesNo
Secondary Guardian's Name

First NameLast Name
Relationship to Child
Email
example@example.com
Phone Number
Please enter a valid phone number.
Case Manager (if applicable)

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Child's Background Information
Please fill this out to the best of your ability. All information shared is confidential. We want to make sure this child, as well as other campers, have a safe, healthy, and fun week at camp. This information is extremely helpful and is only shared with camp staff on a "need-to-know" basis.

Any information shared regarding the child's behavior / mental health will not disqualify the child’s attendance. We just want to be prepared to serve your child to the best of our ability. Prior to camp, you will be contacted by a member of our Care Team to confirm the details you've shared and allow for any other information you think would be helpful for us to know.
Number of known placements (including current placement)?*
How long has this child been in the current placement?*
Does this child have current visitations with biological parent(s)?

YesNoUnknown
Has this child been to a Royal Family KIDS Camp before?*

YesNoUnsure
If yes, what did he or she like about camp? What positive changes or behaviors did you see upon their return home?
Please describe what makes camp especially important for this child.*
While children attending multiple RFK Camps have a strong potential to be accepted, priority will be given to children who only have the opportunity to attend one camp.*

This child plans to attend multiple RFK Camps this summerThis child is only attending this RFK Camp
Child's Swimming Ability*
Do any of the following behaviors apply to this child? (This information helps us prepare for a successful camp experience and will not be used to disqualify the child.)*

Afraid of the darkAggressive behaviorAudio (hearing) sensory issuesBed wettingBiting (self or others)Chews or bites nails excessivelyDifficulty following directionsDifficulty sitting still (e.g. wiggling or fidgeting)Difficulty swallowing or chokes easilyFrequent lying / exaggerating realityHiding or hoarding foodHistory of running awayHyperactiveIssues surrounding foodLearning delays or disabilitiesNeeding a fidget / stimulation while listeningNeeding to move constantly (e.g. spinning or jumping)Nightmares or night terrorsSexual behaviors that are beyond developmental stage of the childSpeech delaysStealingTactile (touch) sensory issuesTantrums or physical outburstsWithdrawing when upset (e.g. getting quiet)None of the above
If any of the above apply, please elaborate (including triggers to avoid, best practices & redirection tactics):
Has this child been a victim of sexual abuse?*

YesNoUnknown
Has this child been a victim of physical abuse?*

YesNoUnknown
Does this child have a history of suicidal thoughts or self-harm behaviors that you are aware of?*

YesNoUnknown
Are there any other concerns you would like to discuss with one of our Child Specialists / Therapists prior to camp?
Tell us a little more about this child (this will help us provide encouragement and participation)*

Active / energeticFunny sense of humor / wittyGreat storyteller (different than lying)Less active / prefers to do things that are more quiet or reservedLikes animals / insectsLikes art / being creativeLikes building (legos / wood projects)Likes helping othersLikes musicLikes readingLikes sportsLikes swimmingLikes to act / be involved in dramasLikes to try new thingsNeeds help trying new thingsMakes friends easilyNeeds help making friendsPicky eaterPrefers smaller groups
Does this child have any other characteristics, interests, or specific ways they like to engage in play? Be specific. We're happy to know as much as you're willing to share.
Does this child know any other children who are planning to attend camp?*

YesNo
If yes, please provide the name(s) and any information we should know about the relationship dynamic between these children?
Health & Medical History
If your child requires medication during camp (prescription or over-the-counter), please note that MEDICATION SHOULD ARRIVE IN THE ORIGINAL CONTAINER with instructions clearly indicated otherwise medication cannot be administered. The RFK Registered Nurse will collect and label all medication at registration on Monday morning (June 30, 2025). Please do not pack medication in luggage.
Does this child's medical history include any of the following?

Anaphylactic ShockArm or leg bracesBack injury or bracesBalance issuesDiabetesDiagnosed eating disorderFainting or dizzy spellsFoot / feet braces or surgeriesHearing aids or hearing impairmentHeart conditionHypoglycemiaPulmonary EdemaRespiratory or breathing problemsSeizuresSkin issues / rashes / easily bruised
Are there any other medical or health-related conditions we should be aware of?
Are there any specific activities that should be restricted?
Please list any known allergies:
Does this child need close access to an epi pen?*

Yes, an epi pen will be sent to campNo
Does this child have asthma?*

Yes, an inhaler will be sent to campNo
Is this child taking any medication?*

YesNo
Please list all prescription or over-the-counter medications
Is there any additional information we need to know about the above prescriptions, vitamins, or over-the-counter medications being sent to camp?
Primary Doctor*

First NameLast Name
Doctor's Phone*
Please enter a valid phone number.
The following items will be kept in our camp infirmary to be used only if needed. Please indicate below if the RFK Registered Nurse has permission to administer any medication needed or just the medications selected:*

Nurse is permitted to administer any medication neededAcetaminophenAntihistamineAnti-fungal creamArtificial tearsBacitracin Ointment (cuts/abrasions)BenedrylBetadine (topical antibacterial cleanser)Cough syrupCough dropsDecongestantDramamine (motion/car sickness)IbuprofenInsect repellentImodium (diarrhea)Ipecac syrupMiraLax (constipation)Pepto BismolRash OintmentSwimmer's ear dropsTums
Permission to Administer*

I understand that it is my responsibility as caregiver to make sure that all instructions on medication(s) sent to camp are clear and that medications arrive in their original containers. I hereby authorize the RFK Registered Nurse to administer the above medication(s) according to manufacturer's instructions or as otherwise specified.
Has this child had any serious illness, injuries or medical operations in the last 3 years?*

YesNoUnknown
Please list illness or operation(s):
Are all immunizations current for this child?*

YesNoUnknown
Person(s) Authorized to Pick Up

Please list adults who are authorized to pick this child up (GOVERNMENT I.D. WILL BE REQUIRED)
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Medical Authorization & Release

Must be signed by Legal Guardian, Case Manager, or Social Worker
The medical and health history is correct to the best of my knowledge 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 sugical 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 participate in any camp program, unless revoked in writing by the undersigned and delivered to the Director of Royal Family KIDS Camp as legal guardian/social worker/other.
Name of Legal Guardian, Case Manager or Social Worker*

First NameLast Name
Date*

MonthDayYear
Date
Signature of Legal Guardian, Case Manager or Social Worker*

Clear
We look forward to spending the week with your child at camp!

Please don't hesitate to reach out with any questions.
Should be Empty:

CAMPER APPLICATION

Child's Background Information

Health & Medical History

Person(s) Authorized to Pick Up

Medical Authorization & Release

We look forward to spending the week with your child at camp!