2026 RFKC Camper Application

DO NOT PRINT THIS APPLICATION...MUST BE FILLED OUT AND SUBMITTED ONLINE. Contact sylvia@jamessamaritan.org if you have any difficulty or questions about this form.
Saturday, February 14th- Wednesday, February 18th, 2026

Drop off @8:30am Feb 14th and Pick up Feb. 18th @ noon at FBC Covington 16333 LA-1085
HAVE AN ADOPTED CHILD? If a returning RFK camper has been adopted since last year's camp, they are still eligible to attend camp with us. If they have NOT attended camp and are adopted, we will consider taking them to camp with us if we are not able to fill camp with foster children.
Name of Person Filling Out This Application*

First NameLast Name
Your Email Address
example@example.com
Child's Information
Child's Name*

First NameLast Name
Preferred Name (the one they want on personalized items)
Gender*

MaleFemale
Birthdate*

MonthDayYear
Age at Time of Camp*

7 years old8 years old9 years old10 years old11 years oldOther
Emotional Age*
Child's T-Shirt Size*

Child SChild MChild LChild XLAdult MAdult LAdult XL
Is this child a returning RFK Camper?*

Yes, returning RFK CamperNo, not a returning RFK CamperDon't know if child has been to RFKC before
If yes, what year, city, and state?
Are you interested in finding out how this child can be part of the RFK Club & Mentor Program throughout the year?*

Yes - Please send more information!Maybe - Please send more information!No, thank you
Siblings of Child Applying to RFKC

If siblings of this child will ALSO be applying to attend RFK camp, please provide their info. NOTE: We will still need an application for each sibling.
If a sibling of this child is applying to camp, please tell us who that is.

First NameLast Name
This sibling is a...

Biological SiblingFoster SiblingSibling in Adoptive Family
If 2nd sibling is applying to camp, please tell us who that is.

First NameLast Name
2nd sibling is a...

Biological SiblingFoster SiblingSibling in Adoptive Family
If 3rd sibling is applying to camp, please tell us who that is.

First NameLast Name
3rd sibling is a...

Biological SiblingFoster SiblingSibling in Adoptive Family
If 4th sibling is applying to camp, please tell us who that is.

First NameLast Name
4th sibling is a...

Biological SiblingFoster SiblingSibling in Adoptive Family
Parent/Guardian Information
This home is best described as...*

Foster HomeAdoptive ParentsGroup HomeResidential TreatmentKinship PlacementBiological ParentOther
If this child was adopted, when did you adopt him or her?

MonthDayYear
Approximately when was this child placed in the current home?

MonthDayYear
how many times has this child moved placements*
Mailing Address (for camp correspondence)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Caregiver #1*

First NameLast Name
Relationship to Child*
Best Phone Number*

Area CodePhone Number
Caregiver #1 Email Address*
Must be a working email
Caregiver #2

First NameLast Name
Relationship to Child
Caregiver #2 Best Phone Number

Area CodePhone Number
Caregiver #2 Email Address
Persons authorized to pick this child up from camp
Who is the authorized adult that will be picking this child up from First Baptist Covington after camp on Wed. Feb 18th at noon? **Government ID required***

First NameLast Name
Cell Number for Authorized Adult #1*

Area CodePhone Number
SECOND adult authorized to pick up this child from camp. **Government ID required**

First NameLast Name
Cell Number For Authorized Adult #2

Area CodePhone Number
Caseworker/Child Placement Agency Information
Child Placement Agency (Current or Past if Child Has Been Adopted)*
Caseworker Name*

First NameLast Name
Caseworker Email*
Caseworker Cell #*

Area CodePhone Number
Supervisor's Name

First NameLast Name
Supervisor's Cell #

Area CodePhone Number
Background/Behavior Information

Please fill this out to the best of your ability. We want to make sure your child has a safe, healthy, fun time at camp. This information is extremely helpful and will NOT affect their eligibility to attend camp.
DOES THIS CHILD:*

Wet the bed?Take items that don't belong to them?Have nightmares or night terrors?Hoard food?Have an eating disorder?Have difficulty reading or writing?Run away?Act out sexually with other children?Pay inappropriate attention to adults?Have frequent tantrums?Become physically violent when angry?NONE
Please describe any items checked above and what has been successful in managing these behaviors.
BE SPECIFIC
How would you describe this child's activity level?*

Sometimes hyperactiveAlways hyperactiveDon't know about activity levelAverage activity level for ageUnder-active/lethargic
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 entering foster care and since? What circumstances is this child dealing with?*
If this child attended Royal Family KIDS' Camp in the past, what did he or she like about it? What positive changes or behaviors did you see upon their return home?
Please let us know the strengths of this child. Please write as much as you'd like!*
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!)*
Any additional information you need for our staff or counselors to know while your child is up at camp?
Medical History + Prescription Medication Information
Please attach a picture of the child's medical insurance card. *
List all known allergies to food, plants, medications, animals, etc.*
Illnesses and Medical Complications Past or Present (check all that apply)*

Respiratory ProblemsFood AllergiesMedicine AllergiesTopical Allergies (lotion, sunscreen, etc.)Dizzy Spells and/or FaintingFoot ProblemsBack ProblemsSeizure DisordersAnaphylactic ShockBalance ProblemsAsthmaADD or ADHDHypoglycemiaHeart or Circulation ProblemsPulmonary EdemaHay FeverPoison Oak/Poison Ivy AllergiesDiabetesInsect Bite Allergies (i.e. mosquitoes, bees, wasps, etc.)Recent SurgeryRecent Broken BonesNONEOther
Please explain each medical issue you checked above. (If you did not check anything, please say DOES NOT APPLY."*
What specific activities should be DISCOURAGED for medical reasons while at camp?
Please check ALL items that you authorize the medical staff and/or staff to administer during the week of camp.*

Sunblock/SunscreenInsect RepellantLip BalmRash OintmentTylenol or AdvilAntiseptic OintmentBandaidsAnti-Itch CreamHydrogen PeroxideRubbing AlcoholCough SyrupCough DropsDecongestantAntihistamineOther
Please explain why you said NO to the medications you checked above. (If you did not check any, just say DOES NOT APPLY.)
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, in it's original container, for the duration of camp. I authorize RFKC medical staff to administer the medications.*

Yes, I understand that sharing medical info, medications, and dosages are my responsibility.No, I do not understand that sharing medical info, medications, and dosages are my responsibility.
Please list all prescription or over the counter medications that this child takes on a regular basis (We ask that if the child takes a medication, it be sent to camp with them. We have camp nurses to distribute meds.
Additional information we need to know about the above prescription drugs, vitamins, or over-the-counter medications sent to camp - or - additional meds if any.*
Physician, PA, or NP for Child*

First NameLast Name
Physician, PA, NP, or Clinic Phone Number*

Area CodePhone Number
Should be Empty:

DO NOT PRINT THIS APPLICATION...MUST BE FILLED OUT AND SUBMITTED ONLINE. Contact sylvia@jamessamaritan.org if you have any difficulty or questions about this form.

Saturday, February 14th- Wednesday, February 18th, 2026

Child's Information

Siblings of Child Applying to RFKC

Parent/Guardian Information

Persons authorized to pick this child up from camp

Caseworker/Child Placement Agency Information

Background/Behavior Information

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!

Medical History + Prescription Medication Information

Prescription & Over-the-Counter Medications