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: This week is full: on wait list only
- 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 - 11 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.
Please select the week for which the child is registering.
Full Legal Name of Camper

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

MonthDayYear
Date
Gender of Camper
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
Choose all that apply:
Child is currently living with:

Other
(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 T-Shirt Size
Child's History
Number of known placements for foster child (including current placement)
Please mark all that apply to child's current emotional or behavioral concerns.
Other concerns that I would like to discuss with the camp Child Placement Coordinator prior to camp:
Has the camper been the victim of sexual abuse?
Has the camper been the victim of physical abuse?
How long has the child been in the care of their present placement?
Camper Details
Please tell us a little about your camper.
Other characteristics unique to this child you'd like us to know:
Health & Medical History
Please mark all that apply:
Are any activities to be restricted?
Does the child have any of the following known allergies?

Other
Please detail above allergies or describe "other":
Does your child need to have close access to an Epi pen?
Does the camper have asthma?
Prescription Medications
Does the child take any medications?
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
Has the child had any serious illness, injuries, or medical operations in the last three years?
Please list illness or operations:
Are all immunizations current for the camper?
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!