2026 Restored Hope Adventure Camp
Name
First Name
Last Name
Camp Dates Request
Please Select
June 28-July 2
Please note the date change this year. We are running Sunday-Thursday June 28-July 2
Childs age at camp
Birthday
-
Month
-
Day
Year
Date
Care Giver Name
First Name
Last Name
Care giver phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Care giver email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
T-shirt Size
Known Allergies or medical condition
Yes
No
If yes explain here.
Taking any medication
Yes
No
If yes can they give themselves their own meds?
Yes
No
MEDICAL RELEASE FORM: 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 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 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, hospital, camp or elsewhere. Pertinent protected health information of the camper may be released to the nurse for purposes of evaluation and treatment of the camper during the week of camp. This authorization will remain effective while the above minor is enroute 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. I give my permission for the above mentioned minor to attend Royal Family KIDS Camp.
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