2026 Camper Application

2026 CAMPER REGISTRATION FORM

Royal Family KIDS Chapter #289 - Serving Eastern North Carolina
This application must be completed in its entirety for your child to be considered for our summer camp. Please attach your child’s immunization record and a photo of your child. You will be notified upon receipt of the application. Applications should be submitted by April 1, 2026. You will be provided packing instructions and other important information once your child’s application has been approved.

July 6 - 10
- We welcome campers ages 6 - 11 at the time of camp.
- All 11 year olds at the time of camp will be considered graduates.
- Camp drop-off is in Dunn, NC
- Questions: Contact Heather Tetterton Heathermh1978@gmail.com
- Need a physical copy, click here to print and return to Heather.
July 20 - 24
- We welcome campers ages 6 - 10 at the time of camp.
- Camp drop-off is in Durham, NC
- Questions: Contact Kristen Ferree kristenferree@yahoo.com
- Need a physical copy, click here to print and return to Kristen.
July 6 - 10 (drop-off and pick-up in Dunn, NC)July 20 - 24 (drop-off and pick-up in Durham, NC)
Full Legal Name of Camper*

First NameMiddle NameLast Name
Preferred Name/Nickname of Camper
Date of Birth: *

MonthDayYear
Date
MaleFemale
Current Age of Camper: *
Estimate of Developmental Age of Camper*
Upload picture of Camper here if available

Upload a File

Cancelof
Upload the immunization record if available

Upload a File

Cancelof
This is Camper's first time at Royal Family KIDS CampCamper has been to camp beforeCamper has siblings coming to camp
Foster ParentRelativeGroup HomeOther
(Primary) Name of Person Child is Living With: *

First NameMiddle NameLast Name
Best phone number to to contact primary caregiver*

Area CodePhone Number
(Secondary) Name of Person Child is Living With:

First NameMiddle NameLast Name
Best phone number to to contact secondary caregiver

Area CodePhone Number
Address Where Child is Living: *

Street Address

Street Address Line 2

CityState

Postal / Zip Code
E-mail of Primary Contact:*

Confirmation Email
Social Worker/Case Worker Name:

First NameMiddle NameLast Name
Social Worker/Case Worker Phone Number:

Area CodePhone Number
Social Worker/Case Worker Email:

Confirmation Emailexample@example.com
Child Emergency Contact*

First NameMiddle NameLast Name
Relationship (of Emergency Contact)*
Phone Number (of Emergency Contact) *

Area CodePhone Number
Child SmallChild MediumChild LargeChild XLAdult SmallAdult MediumAdult LargeAdult XL
Child's History
Number of known placements for foster child (including current placement)
AggressiveBitingBedwettingEating disordersLearning delays or disabilitiesHyperactiveSpeech delaysNight terrors, nightmares, frequently awakes in the nightStealsFrequently lies or exaggerates reality (dramatic)Runs awayTantrums or physical outburstsSexually acting outActs much more mature than their ageActs much more immature than their ageAudio (hearing) sensory issuesTactile (touch) sensory issuesLikes to spin, jump or be constantly movingWiggles or fidgets when trying to sit stillHas difficulty following directionsWithdraws or gets quiet when upsetHas emotional or physical outbursts when upsetHides or hoards food or other itemsDifficulty swallowing or chokes frequentlyClumsy, falls or crashes into things oftenNeeds to fidget or draw while listeningChews or bites nails excessively
Other concerns that I would like to discuss with the camp Child Placement Coordinator prior to camp:
YesNoUnknown
YesNoUnknown
How long has the child been in the care of their present placement?
Camper Details
Likes to swimLikes musicLikes to draw or is artistic and creativeLikes sportsLikes animalsLikes to fish or wants to tryMakes friends easilyNeeds help making friendsLikes to try new thingsNeeds help trying new thingsIs very active and energeticIs less active and prefers to do things that are more quiet and reservedLikes to build things (legos, wood projects, etc.)Likes to readHas a funny sense of humor or is wittyIs very helpful and likes to help othersIs very neat and tidyIs more sloppy/messy - has a hard time keeping track of things or loses things easilyIs a great eater (different than unhealthy over eating)Is a picky eaterPrefers smaller groups and one on one activitiesLikes big groups and noise and activityLikes to act or be involved in plays/dramaIs a great story teller (different than lying)Can shower and bathe without assistancePrefers total darkness at night when sleepingNeeds some assistant bathing, washing hair etc. (note: the child is never alone at camp with another child or an adult - we do have alternative methods of helping a child shower/bathe with supervised assistance to their needs)Is afraid of the dark at night
Other characteristics unique to this child you'd like us to know:
Health & Medical History
Child has leg or arm bracesDiagnosed eating disorderHeart conditionHypoglycemiaBack injury or bracesDiabetesSeizuresHearing aids or hearing impairmentRespiratory or breathing problemsPulmonary EdemaFainting or dizzy spellsAnaphylactic shockFoot/feet braces or surgeriesBalance problemsSkin issues/rashes/lesions/bruises easily
Are any activities to be restricted?
BeesOther insect allergiesSeasonal (please list below)Food allergies (please list below)Dairy allergiesDrug allergies (please list below)Gluten (please indicate sensitivity or diagnosed celiac)NoneOther
Please detail above allergies or describe "other":
Does your child need to have close access to an Epi pen?
YesNoThe camper has an inhaler that will be sent to camp with them.
Prescription Medications
YesNo
Please list all medications, dosage & reason for taking.

Medication NameDosage Diagnosis or Reason for taking
Medication NameDosage Diagnosis or Reason for taking
Medication NameDosage Diagnosis or Reason for taking
Medication NameDosage Diagnosis or Reason for taking
Medication NameDosage Diagnosis or Reason for taking
Prescribing Doctor's Name

First Name Middle Name Last Name
Doctor Phone Number

Area CodePhone Number
YesNo
Please list illness or operations:
YesUnknownNo
Other medical conditions we need to know about the camper:
Authorized Person(s) to Pick Up Child:

Authorized person(s) will need to show identification and be cleared with Child Placement Coordinator to pick up child. Children will NOT be released to unauthorized or previously cleared person(s). PLEASE ARRIVE AT PICK UP LOCATION on time. (The pick up location, date, and time to be announced)
Person Authorized to Pick Up Child: *

First Name Middle Name Last Name
Phone Number*

Area CodePhone Number
Person Authorized to Pick Up Child:

First Name Middle Name Last Name
Phone Number

Area CodePhone Number
Person Authorized to Pick Up Child:

First Name Middle Name Last Name
Phone Number

Area CodePhone Number
Medical Authorization and Release:

Must be signed by Case Worker/Social Worker or Legal Guardian
Printed Name of Legal Guardian/ Caseworker or Social Worker

First NameLast Name
Signature of Legal Guardian/ Caseworker or Social Worker
We look forward to spending time with your child at CAMP!

Please don't hesitate to reach out with any questions about Camp or the above application.
Should be Empty:

2026 CAMPER REGISTRATION FORM

Child's History

Camper Details

Health & Medical History

Prescription Medications

Authorized Person(s) to Pick Up Child:

Medical Authorization and Release:

We look forward to spending time with your child at CAMP!