2025 Camper Application

Love Fosters Hope Camper Application - Summer 2025

GREATER HOUSTON, TX AREA
Love Fosters Hope provides free sleep over summer camps for children and teens between the ages 7 to 19 years old and who are in the foster care system.
Select the appropriate camp according to the camper's age and biological sex.*

Royal Family Kids Camp- June 9th-13th, 2025 (Co-ed 7-11 years old)Teen Reach Adventure Camp for GIRLS June 19th - 22, 2025 (Girls 12 to 15 years old)Teen Reach Adventure Camp for BOYS June 26th-29th, 2025 (Boys 12 to 15 years old)Bridge Camp July 10th- 13th, 2025 (Co-ed 16 to 19 years old)
CAMPER INFORMATION

You must complete the entire application for each child.

All information will be kept confidential.
Camper's Name*

First Name (LEGAL)Last Name (LEGAL)PREFERRED First Name (NICKNAME)
Gender at Birth*

MaleFemale
Birth Date*

MonthDayYear
Actual Age at Time of Camp*
Mental Age*
Emotional Age*
Grade (current school year: 2024-2025)*
Estimated year of high school graduation*
Shoe Size*
T-shirt Size*

Child SChild MChild LAdult XSAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XL
Short Size*

Child SChild MChild LAdult XSAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XL
RFKC - Girls Dress Size (If your camper is a boy, please select N/A)*

N/A6-77-89-1011-1214Other
Ethnicity*

Hispanic or LatinoNon-Hispanic or Latino
Race*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite
Child or teen's PERSONALITY (mark ALL traits that describe the camper MOST of the time)*

SocialSeriousDeterminedPerformerEnergeticPlannerPeacekeeperKindTalkerShyAthleticOptimisticHumorousOrderlyObserverNegativeQuietCompetitivePerfectionistLeader
Child or teen's INTERESTS (mark ALL interests of the camper)*

ReadingArts/CraftsShoppingDancingMusicSingingRappingMoviesActingHikingCard GamesSwimmingIndoor ActivitiesOutdoor ActivitiesVideo GamesPlaying Board GamesOther
Has the child or teen attended any of our camps IN THE PAST? If so, mark which ones.*

Royal Family Kids Camp (ages 7-11)Teen Reach Adventure Camp (ages 12-15)Bridge Camp (ages 16-19)Camper has not attended any of the camps listed above
LEGAL GUARDIAN RELATIONSHIP
Name of person with whom teen is living*

Guardian First NameGuardian Last Name
What name does this child call his/her current guardian? *
Legal Guardian Relationship to youth.*

Foster ParentAdoptive ParentGroup HomeKinship placementBio ParentOther
Group Home Name*
If you answered Kinship placement on the previous question, select the relationship to the child. *
Address*

Street Address

Street Address Line 2

CityZIP Code

County
Cell Number*

Area CodePhone Number
Home Number

Area CodePhone Number
Work Number

Area CodePhone Number
E-mail*
example@example.com
Length of time the child has lived in this home. (Ex: 2 weeks, 8 months, 1 year) *
Names and ages of other foster children living in this home. Please include First Name, Last Name, Age, & if you have submitted an application for this child to also attend one of our camps. If yes, which one? Please put N/A if not applicable. *
CASE WORKER INFORMATION
Case Worker's Name*

First NameLast Name
Case Worker’s Phone Number*

Area CodePhone Number
Case Worker’s E-mail*
example@example.com
Case Worker’s County*
Case Worker Supervisor's Name

First NameLast Name
Supervisor's Phone Number

Area CodePhone Number
Supervisor’s E-mail
example@example.com
MEDICAL HISTORY
Doctor's Name*

Doctor First NameDoctor Last Name
Doctor's Phone Number*

Area CodePhone Number
Facility Name*
Health Insurance/Medicaid*
Health Insurance/Medicaid Policy Number*
Approved Medical Facility
Emergency Prescription Source
Emergency Prescription Source's Phone Number

Area CodePhone Number
Are your child's immunizations current?*

YesNo
If you selected YES to the previous question about immunizations being current, please list the name of the PUBLIC SCHOOL the child is attending. If you selected NO, please write "will e-mail record" & e-mail the immunization record once it is up to date to Love Fosters Hope Program Director, Samantha Mackey, at Samantha@lovefostershope.org.*
Does your child have seasonal allergies*

YesNo
Please list specific seasonal allergy and severity (mild, moderate, life-threatening) of allergic reaction. *
Medication required to treat seasonal allergy. *
Does your child have food/drug allergies?*

YesNo
Please list specific food or drug allergy and severity (mild, moderate, life-threatening) of allergic reaction. If a PEANUT ALLERGY, RFKC CANNOT ensure that campers are not exposed to peanuts/or peanut butter, therefore unfortunately we CANNOT accommodate a child with peanut allergies at our camp. *
Medication required to treat food or drug allergy. *
Is your child allergic to bees?*

YesNo
Please list severity (mild, moderate, life-threatening) of allergic reaction. *
Medication required to treat bee allergy: *
Does your child carry an EpiPen?*

YesNo
Please list all reasons your child carries an EpiPen.*
List ANY of the child's known medical conditions (mental or physical), illnesses or surgeries treated by a doctor in the last year. If none, type “N/A"*
List ANY disabilities or other limitations that would help us better care for your child. (Select all that apply).*

AutismCerebral PalsyIntellectual DisabilityOrthopedic ImpairmentADHDVisually ImpairedEmotional DisabilityHearing ImpairedODD - Oppositional Defiance DisorderNoneOther
Is your child diabetic? If yes, we must have a medical release signed by their doctor*

YesNo
Is your child pregnant? If yes, the we must have a medical release signed by her doctor*

YesNo
Does your child have asthma? If yes, the we must have a medical release signed by their doctor*

YesNo

Please List ALL medications your child is taking (including over-the-counter drugs). If none fill in one line with "N/A".*

	Name of Medicine	Reason	Dosage/Amount	Time Given
1
2
3
4
5
6
7
8
9

NOTE: MEDICATIONS MUST BE IN ORIGINAL PRESCRIPTION BOTTLES FROM PRESCRIBING PHYSICIAN
EMOTIONAL & BEHAVIORAL HISTORY
What difficult events has your child experienced in their lifetime (that you are aware of)? Check all that apply.*

Death of a loved oneIncarceration of a loved onePhysical abuseVerbal abuseSexual abuseWitnessing violence (domestic or otherwise)Exposure to substances (drugs/alcohol)NeglectMedical traumaBullyingOther
Please describe the relationship this child has with his/her current guardian. (Check any that apply)*

CaringRespectfulCloseFearfulSubmissiveGuardedDefiantDisrespectfulDistantTenseOther

Indicate with an "X" the degree to which your child displays the following emotions/behaviors. Please answer honestly. Negative behaviors do not disqualify your child from participating in our programs.*

	FREQUENTLY	SOMETIMES	NEVER
Aggression/Anger
Bedwetting
Biting
Hyperactive
Learning Difficulties
Lying
Nightmares
Night Terrors
Runs Away
Tantrums
Acting Out Sexually
Stealing
Withdrawn
Night Walking
Eating Disorder

Please list triggers (words, phrases, items, or actions) and calming methods (distraction, quiet time, special toy/blanket, calling current guardian) for all "sometimes" & "frequent" behaviors selected on previous question. *
For Eating Disorders, select all that apply.*

Taking/Hiding/Hoarding foodUncontrolled EatingAnorexiaN/A - Not applicableOther
How does your child typically respond to new adults? Check any that apply.*

Compliant/follows directionsDefiant/Pushes against the rulesTries to push boundariesTries to pleaseNeeds gentlenessNeeds assertivenessRespectfulDisrespectfulOther
If your child is female, is she fearful of men? If yes, please explain. Our programs have both men and women who serve in various roles. All our volunteers have been carefully screened and trained. *
Has your child been assigned to an alternative education program this school year?*

YesNo
If yes, for how many days total and for what offense(s)?*
Does your child have any criminal history? Please mark yes if there are any pending charges/cases, probation, etc.*

YesNo
If yes, please list all pending charges/cases, probation, etc. Please put N/A if not applicable. *
Is there anything else we should know about your child in order to better meet their needs?*

EMERGENCY CONTACT
Please provide at least one EMERGENCY CONTACT that can be contacted about your child at any time during camp in case of an emergency. This person may be contacted prior to camp to confirm contact information.
Emergency Contact #1*

First NameLast Name
Relationship to you or your Child*
Emergency Contact Phone Number*

Area CodePhone Number
Emergency Contact #2

First NameLast Name
Relationship to you or your Child
Emergency Contact Phone Number

Area CodePhone Number
LEGAL GUARDIAN CONSENT
As Legal Guardian of the named child, I hereby agree that all information provided to Love Fosters Hope is correct and I approve their participation in a Love Fosters Hope Camp Program.
Legal Guardian Name*

First NameLast Name
Legal Guardian Signature*
Date*

MonthDayYear
Date
Teen Name (if age 18 and above)

First NameLast Name
Teen Signature (if age 18 and above)
Date

MonthDayYear
Date
Confirmation

BY ACKNOWLEDGING AND SIGNING ABOVE, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Love Fosters Hope

2001 Timberloch Pl Ste500

The Woodlands, TX 77380

www.lovefostershope.org

Samantha@lovefostershope.org

832-823-1889
Should be Empty:

	YES	NO
Sunscreen
Insect Repellant
Lip Balm
Rash Ointment
Tylenol
Ibuprofen
Antiseptic Ointment
Band-Aid
Anti-itch Cream
Alcohol Wipes
Cough Syrup
Cough Drops
Decongestant
Antihistamine
Pepto-Bismol
Tums
Other

Love Fosters Hope Camper Application - Summer 2025

CAMPER INFORMATION

LEGAL GUARDIAN RELATIONSHIP

CASE WORKER INFORMATION

MEDICAL HISTORY

EMOTIONAL & BEHAVIORAL HISTORY

PERMISSION TO ADMINISTER FIRST AID AND OVER-THE-COUNTER MEDICATIONS