2026 RFK West LA Camper Application

  • RFKC West LA Camper Application 2026

    Hosted by Cornerstone West LA

  • Camp Dates:

    MONDAY August 3 - FRIDAY August 7, 2026

    Please fill out the following application to the best of your ability.

    We want your child to have the best experience possible at camp and appreciate and value your input.

    Please start the application when you have the following items available:

    *Child's Medi-Cal number

    *A recent picture of the child available to upload

    If you have any questions or issues completing the application,

    please email us at: rfkwestla@gmail.com

    or call the Camp Co-Director Mariana at (203) 970-8772

    NOTE: Applications for boys will be put on a waitlist since we are full

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  • How did you hear about our camp?*

  • Choose one:*
  • Will your child be applying to attend other RFK camps during summer 2026?

  • Camper Information

  • Gender*
  • Birth Date:*
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  • Caregiver and Emergency Contact Information

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  • Agency and/or DCFS Information

  • This case is currently managed through:*
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  • This case is currently:*

  • Sibling Information

  • Behavior

    Please answer to the best of your ability. These answers help us better support your child while at camp.
  • Does the child have any eating behaviors or food issues?: *

  • Does this child have any trouble at night time?*

  • Please let us know if or how this child may act out sexually:*

  • Medical History

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  • Does the child have any allergies (e.g. drugs, food, environmental, etc.)?*
  • Is the child up to date on all age-appropriate immunizations?*
  • Does the child have any of the following medical issues or concerns?

  • Has the child had any recent illnesses or medical complications?*
  • Does the child have any disabilities or limitations?:*
  • Does the child wear arm or leg braces?*
  • Does the child currently wear hearing aids?*
  • Does the child currently wear glasses?*
  • Does the child currently take any medications?*
  • Does the child have any issues taking their medications?*
  • All medication sent to camp must be sent in the original container with the pharmacy label on it. I understand that it is my responsibility as caregiver to make sure that all instructions are clear and that the necessary dosage is adequately supplied for the duration of camp. I hereby authorize RFKC's nurse to administer the above medication from August 5, 2019 to August 9, 2019.*
  • How many medications will your child be bringing to camp?*
  • Does the child have any dietary restrictions or special dietary needs?*

  • Permission to Administer Over-the-Counter Medications

  • Rows

  • Consent and Signature

  • 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, at a hospital, camp or elsewhere. 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 named minor to attend Royal Family KIDS Camp August 2-6, 2021 through Cornerstone West LA.

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