Royal Family KIDS Camp Thousand Oaks Camper Application
Campers: Children who are 7-11 years old at the time of camp. Activities include: swimming, dancing, music, a talent show, engaging bible stories, thoughtful activities and art projects, cabin stories, dress up, games on the lawn, lizard catching, tea parties, and a BIG "Everybody's Birthday" Party celebration!!
Camp Dates: August 4th-8th (Drop off & Pick Up in Westlake Village, CA)
Please note: Campers may only attend one Royal Family Kids Camp per year, regardless of the location. This helps ensure that every eligible child has the opportunity to experience camp, as spots are limited across all sites. Application Instructions: This form must be completely filled out. The information is vital to the health and well-being of your child. Your application will not be valid if it is not filled out completely. Submission of this application does not guarantee your child's reservation for Royal Family KIDS Camp 2025. PLEASE FILL OUT A SEPARATE FORM FOR EACH CAMPER:
Email
*
example@example.com
Child’s Name
*
First Name
Last Name
Preferred Name
Sex
*
Please Select
Male
Female
Child’s Date of Birth
*
-
Month
-
Day
Year
Date
Child’s Age
*
7
8
9
10
11
Child’s Emotional Age
*
Child’s Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child’s School
*
Grade
*
Child’s T-Shirt Size
*
Child Small
Child Medium
Child Large
Adult Small
Adult Medium
Adult Large
Child’s is currently living with
*
Relative
Adoptive Parents
Foster Parent
Other*
Caregiver Name
*
First Name
Last Name
Child’s Relationship to Caregiver
*
Caregiver Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Caregiver Email Address *All camp correspondence will be sent here
*
example@example.com
How long has child lived in current home? *Please indicate months/years
*
How many placements/removals to your knowledge?
*
Explain any unusual/challenging family circumstances that make camp especially important for the child: (for example: recent crisis, being moved in foster placement, severe economic needs, etc.)
*
Child’s Important Contacts
Child’s Emergency Contact (in addition to caregiver)
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Relationship to Child
*
Social Worker Name
*
First Name
Last Name
Social Worker Contact Number/ Email
*
Back
Next
Child’s Behavioral History
Aggressiveness
*
Often
Sometimes
Not at all
Bedwetting
*
Often
Sometimes
Not at all
Hyperactivity
*
Often
Sometimes
Not at all
Lying
*
Often
Sometimes
Not at all
Nightmares
*
Often
Sometimes
Not at all
Running Away
*
Often
Sometimes
Not at all
Sexually Acts Out
*
Often
Sometimes
Not at all
Stealing
*
Often
Sometimes
Not at all
Tantrums/Emotional Outbursts
*
Often
Sometimes
Not at all
Withdrawn
*
Often
Sometimes
Not at all
Tantrums/Emotional Outbursts
*
Often
Sometimes
Not at all
If you answered “Often” or “Sometimes” above, please fill out additional details.
Back
Next
Camper Personal Details
We ask the following questions to help us create a safe, nurturing, and responsive environment.
Has your child attended Royal Family Kids Camp before?
*
Yes
No
If so, where?
If they have attended, what was their favorite part of RFKC? (Any activity, event, volunteer they especially enjoyed?)
Is the child able to use the restroom and shower themselves?
*
Yes
No
The child’s swimming ability is
*
Good
Poor
Unknown
Learning Disabilities/Delays?
*
Yes
No
If yes please explain:
Does you child current receive therapy services?
*
Yes
No
Therapist Name and contact information:
Please specify any mental health diagnosis
What do you enjoy about parenting your child?
*
What is difficult about parenting your child?
*
Any known triggers (sounds, words, situations) that may cause your child distress?
*
What helps your child feel safe/calm when they are upset or overwhelmed? Any specific strategies/tools you use to help them regulate?
*
What does your child enjoy doing? Examples: art, crafts, bikes, sports, dress up, etc.
*
Are there bedtime routines or items that help your child sleep? Are there any special considerations we should be aware of for sleep? Example: bedtimes, nightmares, fear of dark, bedwetting.
*
Are there any past/recent experiences (example: neglect, abuse, loss) we should consider when supporting your child?
*
Back
Next
Child’s Health History
Indicate all known allergies, illness, disabilities, physical limitations or medical complications: IF NO KNOWN ISSUES PLEASE PUT "N/A or NONE"
Allergies: Food or Other
*
Illnesses/Medical Complications
*
Disabilities/Limitations
*
Disordered Eating or Food Concerns? Example: hoarding food, hiding food, eating too much/little, only eating specific foods, etc.
*
Any specific activities to be encouraged?
*
Any specific activities to be restricted?
*
Back
Next
Prescription Medications
ALL MEDICATIONS SENT TO CAMP MUST BE IN ORIGINAL CONTAINER WITH PHARMACY LABELS ON CONTAINER AND GIVEN TO THE NURSE AT REGISTRATION. No medications or medicine allowed in camper's luggage.
Is your child taking medications?
*
Yes
No
Medication #1 Name
Medication #1 Dosage and Time of Day Administered?
Reason Prescribed Medication #1?
Medication #2 Name
Medication #2 Dosage and Time of Day Administered?
Reason Prescribed Medication #2?
Medication #3 Name
Medication #3 Dosage and Time of Day Administered?
Reason Prescribed Medication #3?
Pediatrician Name
*
First Name
Last Name
Pediatrician Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Medi-Cal Number/Insurance Name and Policy Number
*
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 each day of camp. I hereby authorize RFK’s Camp nurse to administer the above medication to my child.
*
Yes
I have further questions/concerns, please follow up with me.
Medical Release Form
Please add a recent photo of your child
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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 volunteer directors, nurses, and physicians of Royal Family KIDS Camp, or such substitute as they may designate, as agent for the undersigned to administer the above medication and 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. Specifically, I request the above minor be assisted by camp medical personnel in taking the above prescribed medications and to provide the above minor with Tylenol, Tums, Motrin, and Benadryl as deemed necessary by camp and medical personnel. I give consent for camp medical personnel to communicate with the above minor's doctor if deemed necessary by camp and medical personnel. I agree to hold harmless the volunteer medical personnel who provide care for the above minor. 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 KIDS as legal guardian/social worker/other. I understand that it is my responsibility as caregiver to make sure all instructions are clear and that the necessary dosage is adequately supplied for the duration of camp.
*
I have read and agree that all the information is correct to my knowledge *YesI have additional questions/concerns please contact me
*
Yes
I have further questions, please contact me
Submit
Should be Empty: