2026 Camper Application (Updated)

CHILD REGISTRATION FORM

Please fill out one application per eligible child. Children must be 6.5 -11.5 years old to apply.
RFK Camp #24 Bakersfield, Ca

Camp Dates: June 8-12, 2026

**This form should be completed by the caseworker/social worker, legal guardian or foster parent(s).

Instructions: This form must be completely filled out. The information is vital to the health and wellbeing of the child. Your application will be returned to you if it is not completely filled in.

Applications do NOT guarantee a placement at camp, however, are required to be considered. Acceptance is based upon availability of spots by gender and age group and largely determined by the number of volunteers we have attending camp. Acceptance forms will be mailed out mid-May with more detailed information.
Full Legal Name of Camper*

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

MonthDayYear
Date
Estimate of Developmental/Emotional Age of Camper*
This is Campers 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
E-mail of Primary Contact:*

Confirmation Email
Address Where Child is Living: *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Social Worker/Case Worker Name: *

First NameMiddle NameLast Name
SOCIAL WORKER/CASE WORKER Phone Number: *

Area CodePhone Number
SOCIAL WOKER/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
Childs History
UnknownPoor SwimmerStrong swimmer
Number of known placements for foster child (including current placement)
How long has the child been in the care of their present placement? *
YesNoUnknown
Any family circumstances that may make camp especially important to this child (Separated from biological siblings, recent death of a family member (bio or foster), first time in foster care, recent parental visitations revoked?*
Please mark ALL THAT APPLY to child's current emotional or behavioral concerns: *Marking behaviors does not disqualify your child from camp. This information can be extremely helpful on how our staff can best approach a situation and help your child have a great week by supporting them to the best of their abilities. (If there are any concerns prior to camp, the camp Child Specialist will reach out to further discuss those to give your camper the best possible experience at camp).*

AggressiveBitingBedwettingEating disordersHyperactiveSpeech DelaysNight Terrors, Nightmares, Frequently awakes in the nightStealsFrequently lies or exaggerates reality (dramatic)Runs awayTantrums or physical outburstsSexually acting outActs MORE mature than their ageActs very IMMATURE for 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 excessivelyHas difficulty with transitionsSelf harm, suicidal thoughts or attemptsMakes impulsive decisions that often results in harm of self or othersTakes on parental responsibilities and has difficulty trusting others to care for siblingsHas difficulty expressing feelings through wordsBlames others and does not take responsibility for own actionsBecomes overstimulated or overwhelmed easilyHas difficulties falling asleep at night
Other concerns that I would like to discuss with the camp Child Specialist/Licensed Counselor prior to camp:
Any specific triggers that often provoke negative behavior (Ex: transitions, competitions, lack of physical activity, sharing, etc..)*
Suggested actions that can help regulate the child's behavior to return back to task or activity and keep them moving forward? *
YesNoUnknown
YesNoUnknown
Likes to swimLikes musicLikes to draw or is artistic and creativeLikes sportsLikes animalsMakes friend 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 slopp/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)Prefers total darkness at night when sleepingCan shower and bathe without assistanceIs afraid of the dark at nightNeeds 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)
Other characteristics unique to this child you'd like us to know:
Health & Medical History
Child has leg or arm bracesDiagnosed eating disorderHeart conditionHypoglycemiaDiabetesSeizuresPulmonary EdemaFainting or dizzy spellsAnaphylactic shockBalance problemsSensitive skin/rashes/lesions/bruises easilyRespiratory or breathing issuesHearing lossSickle Cell DiseaseCardiac/Circulatory IssuesRecent Injury or SurgeryVision ImpairmentsHistory of ConcussionWill have a cast, brace or splint on during campTrauma at Birth (premature, excess hospital stay, withdraws, surgery)
Are any activities to be restricted due to medical history *
BeesOther insect allergiesSeasonal (please list below)Latex AllergyDairy allergiesGluten (please indicate sensitivity or diagnosed celiac)Food allergies (specify below)Drug allergies (please list below)Other
Please detail above allergies or describe "other":
YesNo
YesNoN/A
YesNoThe camper has an inhaler that will be sent to camp with them.
YesNo
Please list illness or operations:
Other medical conditions we need to know about the camper:
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
AUTHORIZATION TO ADMINISTER PRESCRIPTION AND/ OR OVER-THE-COUNTER MEDICATIONS.

I hereby give the Royal Family Kids' Camp Licensed Registered Nurse permission to administer the child's prescribed medications and will notify the nurse of any changes in medication, dosages, etc the day of registration. The nurse is authorized to administer the following products according to manufacturer's instructions, or as otherwise specified. I trust the RFKC Licensed Registered Nurse to use his/her best judgment as situations arise, and if in doubt, he/she can call for verification by the care giver and/or the doctor on record. Please check YES or No to consent or not the administration of additional medicinal items below that the camp supplies , if use is necessary. This form must be completely filled out by the primary caregiver (who signs below), or camper may not attend camp.

Please indicate YES or NO for consent:*

Rows	YES , I give consent to administer the following:	No, I do not give consent
Sunblock
Insect Repellent
Rash ointment
Anti-Itch Cream
Acetaminophen (Tylenol)
Ibuprofen (Motrin)
Antihistamine (Allergy)
Cough Drops or Vitamin C drops
Tums, Pepto & like medicine (for upset stomach or heart burn)
Antiseptic ointment or spray (for cuts)
Cold / Flu Medicine

Name of legal guardian, caseworker/ social worker of foster parent authorizing the above:*

First NameLast Name
Signature of Legal Guardian/ Caseworker or Social Worker or Foster Parent *
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).
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:
Printed Name of Legal Guardian/ Caseworker or Social Worker or Foster Parent *

First NameLast Name
Signature of Legal Guardian/ Caseworker or Social Worker or Foster Parent *
Thank you for your interest! We will be contacting families in mid-May with more detailed information.

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

CHILD REGISTRATION FORM

Childs History

Health & Medical History

Prescription Medications

AUTHORIZATION TO ADMINISTER PRESCRIPTION AND/ OR OVER-THE-COUNTER MEDICATIONS.

Authorized Person(s) to Pick Up Child:

Medical Authorization and Release:

Thank you for your interest! We will be contacting families in mid-May with more detailed information.