Language
  • English (US)
  • RFK Camper Application 2021

    Camp for Foster Kids Ages 6-12, July 5-9, 2021
  • Return Completed Application to:

    Royal Family Kids

    5700 SW Dosch Rd

    Portland, OR 97239

  • Instructions:  This form must be completed prior to submission.  Your application will not be accepted if there is any missing information.  This information is vital to the health and well-being of the child. 

    New Campers: Please upload a photo of the camper or mail the photo to the address listed above.

  • Browse Files
    Cancel of
  •  -  -
    Pick a Date
  •  -
  •  -
  •  -
  •  -
  • Camper Success:  At RFK Camp we would like to be able to support your child to ensure they enjoy a successful week at camp.  It is very helpful for us to know a few details regarding their behavior, interests and challenges.  Please be as specific and complete as possible in considering the following areas.  

  •  
  • Camper Details:

     

  • Camper Health History:  Please indicate all known food/environmental allergies, illnesses, disabilities, physical limitations or medical complications.

  •  
  • Prescription Medications:  All medication sent to camp must be in the original container with the pharmacy label on it.

     

  •  
  • Over-the-Counter Medications:  Please give permission to use the medications listed below by indicating YES or NO for each one listed.  This form must be completed by the primary caregiver who signs below.  

  •  
  • Medical Permissions:

    Prescription Medication - 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 RFK's nurse to administer the above listed prescription medication for the date range indicated below.

    Over-the-Counter Medication - I hereby give the RFK's nurse permission to administer the above listed over-the-counter products according to manufacturer's instructions, or as otherwise specified.  I trust the RFK nurse to use his/her best judgment as situations arise, and if in doubt, he/she can call for verification.

    Medical Release - 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.  This 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, dentist, at a hospital, camp or elsewhere.  This authorization will remain effective while the above-minor is en route 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 applicant/camper to attend Royal Family Kids' Camp and receive medication and medical treatment as provided above.

  •  -
  •  -
  • Emergency Contacts:  In the unlikely event of an emergency, RFK will first try to contact the listed Parent or Legal Guardian, followed by the Emergency Contact and finally the Social Worker for the camper.

     

  •  -  -
    Pick a Date
  • Clear
  • Should be Empty: