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
Gender of Camper
Age of Camper:
Date of Birth:

MonthDayYear
Date
Estimate of Developmental/Emotional Age of Camper
Choose all that apply:
Child is currently living with:

Other
Agency currently fostering through :
(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
FFA Case manager Name: *Type N/A if necessary*

First NameMiddle NameLast Name
FFA Case manager #: *Type in own # if this does not apply to you*

Area CodePhone Number
FFA CASE WORKER EMAIL: *Type N/A if necessary*

Confirmation Emailexample@example.com
COUNTY Case manager Name: *Type N/A if necessary*

First NameMiddle NameLast Name
COUNTY Case manager #: *Type in own # if this does not apply to you*

Area CodePhone Number
CHILD Emergency Contact

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

Area CodePhone Number
Child T-Shirt Size
Childs History
CHILD SWIM ABILITY (ALL children will be supervised by lifeguards and adult volunteers during pool time and genders will be separated during that time. Everyone will be required to pass a 'swim test' to be allowed to go in the deep end of the pool. Some life jackets will be available for any non-swimmers & they will stay in shallow end)
Number of known placements for foster child (including current placement)
How long has the child been in the care of their present placement?
Does child have current visitations with biological parent(s)
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).
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?
Has the camper been the victim of sexual abuse?
Has the camper been the victim of physical abuse?
Please tell us a little about your camper. (This helps us encourage enjoyable and confident participation in activities at camp).
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 due to medical history
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?
If your child requires an Epi Pen, do they have one that can be sent to camp?
Does the camper have asthma?
Has the child had any serious illness, injuries, or medical operations in the last three years?
Please list illness or operations:
Other medical conditions we need to know about the camper:
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
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.