Camper Application RFKC 2026

Address Where Child is Living:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email of Primary Contact:*
example@example.com
Confirm Email*
example@example.com
CHILD Emergency Contact*

First NameMiddle InitialLast Name
Relationship (of Emergency Contact)*
Phone Number (of Emergency Contact)*

Area CodePhone Number
Child SmallChild MediumChild LargeChild XLAdult SmallAdult MediumAdult LargeAdult XL
Camper Shoe Size*

Social Worker's Information

We will be sending out an email to Social Worker to sign a PDF once application is received. *Social worker Signature is just making aware that child is attending Royal Family KIDS Camp*
Social Worker/Case Worker Name:*

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

Area CodePhone Number
SOCIAL WORKER/CASE WORKER EMAIL:*
example@example.com
Childs History
Number of known placements for foster child (including current placement)
YesNoUnknown
How long has the child been in the care of their present placement?*
YesNoUnknown

Prescription Medications

Medication Routine needs to stay the same as school routine during camp! Pack enough medication to be taken throughout Summer camp!
YesNo
Please list all medications, dosage & reason for taking:
Please list all medications, dosage & reason for taking:
Please list all medications, dosage & reason for taking:
Please list all medications, dosage & reason for taking:
Unless otherwise instructed below, the Camp Nurse may administer any of the following over the counter (OTC) medications as indicated:

Tylenol/Ibuprofen

Antihistamine/Benedryl

Ipecac Syrup

Pepto Bismol

Imodium

Constipation Relief

Decongestant

Cough Drops

Cough Syrup

Hydrogen Peroxide

Band-aids

Lidocaine (spray/cream)

Cortisone (cream)

Betadine

Eye Ointment

Anti-fungal

Antibiotic Ointment/Neosporin

Lip Balm

Insect Repellant

Sunblock / Sunburn

Rid / Lice Controller
All OTC medications listed above are authorized as needed.Do not administer any OTC medications.OTC medications are authorized except for the following
OTC medications are authorized except for the following:

Childs Medical History
Physician*
Physician Phone Number*
Insurance Company*
Insurance Policy Number*
I understand that it is my responsibility as a caregiver to make sure that all instructions on medications are clear and that the necessary dosage is adequately supplied for the duration of camp. I herby authorize the camp nurse to administer the above medication(s) at camp.
YesNo
Please list illness or operations:
NoYesUnknown
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 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 pick up location, date, and time to be announced)
Person Authorized to Pick up Child:*

First NameMiddle NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.

Person Authorized to Pick up Child:

First NameMiddle NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Person Authorized to Pick up Child:

First NameMiddle NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical Authorization and Release:
The medical and health history is correct to the best of my knowledge about the camper and the above named minor has permission to engage in all prescribed program activities, except as noted. The undersigned do herby 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 doe 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 participate in any camp program, unless revoked in writing by the undersigned and delivered to the Director of Royal Family KIDS Camp as legal guradian/socialworker/other.
Printed Name of Legal Guardian/ Caseworker or Social Worker*

First NameLast Name
Signature of Legal Guardian/ Caseworker or Social Worker*

Powered by Jotform SignClear
Date*

MonthDayYear
Date

Dear Parents, Foster Parents and Social Workers
Dear Parents, Foster Parents and Social Workers! Welcome to a new year at Royal Family KIDS Camp. We are so honored to be entrusted with your camper for an entire week. We believe that your kids are valuable, and so we have made every effort to ensure that your camper has a safe and fun week at camp. As part of our efforts to make camp a great experience we have equipped ourselves with a great staff, nurses and mental health professionals. As camp is a wonderful time for both staff and campers, it can be overwhelming. In order to handle the many emotions that can arise, we have an onsite social worker to help us manage any conflicts that may arise. To consent to have your child interact with the social worker, please sign below. Again. this is to ensure that your child has a great experience at camp.*

Yes, I give consent to the onsite social worker to work with my camper if the need arises.No, I would not like the onsite social worker to work with my camper if the need arises.
Print Your Name*
Signature*

Powered by Jotform SignClear
RFKC Administrative Fee*
prevnext( X )
RFKC Administrative Fee
NON-REFUNDABLE

$25.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty:

Camper Application

Child Information

Social Worker's Information

Childs History

Camper Details

Health & Medical History

Prescription Medications

Childs Medical History

Authorized Person(s) to Pick Up Child:

Medical Authorization and Release:

Dear Parents, Foster Parents and Social Workers