2026 Restored Hope Adventure Camp

Name

First NameLast Name

Camp Dates Request

Please note the date change this year. We are running Sunday-Thursday June 28-July 2

Childs age at camp

Birthday

Date

Care Giver Name

First NameLast 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

CityState / Province

Postal / Zip Code

T-shirt Size

Known Allergies or medical condition

If yes explain here.

Taking any medication

If yes can they give themselves their own meds?

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.