• Image field 144
  • RFK Bureau County 

    Sponsoring Church

    The People Church
    3525 N. Main Street, Princeton, IL 61356

    2026 CAMP DATES: July 26th-July 31st

    Contact for questions:

    Email: info@rfkbureaucounty.org

    Phone Number: 815-915-8229

     

    Cassie Rose - Camp Director

    Lauren Mehrkens - Child Placement Coordinator

     

     

  • About the Child

    This form should be completed by the caseworker/social worker and/or the foster parent(s). Answer all questions to the best of your ability. Any additional information or clarifications can be sent via email.
  • Gender of Camper*

  • Date of Birth: *
     - -
  • Choose all that apply:*
  • Child is currently living with: *

  •  -
  •  -

  •  -

  •  -
  • Child T-Shirt Size*
  • Please tell us a bit more about the child's preferences. Check all that apply.

  • Childs History

  • Does child have current visitations with biological parent(s)
  • Please mark all that apply to child's current emotional or behavioral concerns: (The camp Child Specialist will reach out prior to camp to discuss items marked to give the camper the best possible experience at camp).
  • Has the camper been the victim of sexual abuse? *
  • Has the camper been the victim of physical abuse? *
  • Camper Details

  • Please tell us a little about your camper. (This helps us encourage enjoyable and confident participation in activities at camp).
  • Health & Medical History

  • Please mark all that apply:
  • Does the child have any of the following known allergies?

  • Does the camper have asthma?
  • Prescription Medications

  • Does the child take any medications? *
  •  -
  • Has the child had any serious illness, injuries, or medical operations in the last three years?*
  • Are all immunizations current for the camper?
  • Authorized Person(s) to Pick Up Child:

    Authorized person(s) will need to show identification and be cleared with Social Worker/Case Workers to pick up child. Children will NOT be released to unauthorized or previously cleared person(s). PLEASE ARRIVE AT PICK UP LOCATION (The People Church) NO LATER THAN 2:30pm on August 2nd
  •  -
  •  -
  •  -
  • Medical Authorization and Release:

    Must be signed by Case Worker/Social Worker or Legal Guardian
  • We look forward to spending time with your child at CAMP 2026!

  • If you have questions or need help filling out this form, please reach out to us!

    Email: info@rfkbureaucounty.org

    Phone Number: 815-915-8229

  • Should be Empty: