RFKC

Camper Application

We are excited that you are considering sending your child to RFK camp! Our campers, ages 6–12, are at the heart of everything we do, and we want to make sure their time with us is safe, happy, and full of fun.

To help us provide the best care, please complete this form fully. Every detail you share helps our team understand your child’s unique needs and ensures their health, comfort, and well-being while at camp.

Rest assured, all information is kept completely confidential. Think of this form as a way for us to get to know your child even before they arrive—so we can create a supportive, safe environment where they can grow, be a kid, and make positive memories that last a lifetime.

We cannot wait to welcome your camper to the

RFK camp!

Child's Name and Preferred Name

Child's Medicaid Number

Gender

Age

Emotional Age

School Grade

Date of Birth

Month

Day

Year

School

Reading Ability

Parents/Guardians

Child's Parent/Guardian Name

Relationship

Child's Parent/Guardian Name

Relationship

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Emergency Contact

Relationship

Phone

Social Worker

Phone

Child's Background

How many times has your child moved in foster placement?

Explain any unusual family circumstances that make camp especially important for yourchild. For example, recent crisis, moved into foster placement, severe economic needs, etc

Anything else we need to know about your child?

Camp Questions

Has your child attended a Royal Family Kids Camp before?

Yes

Child's ability to swim...

Unable to Swim

Able to Swim a Little

Able to Swim to the Side of the Pool

Good Swimmer

Any specific activities to be encouraged, discouraged, or restricted?

Medical History

Child's Weight

Allergies to Medications or Food

List any medical conditions, concerns, or activity restrictions.

List any surgeries.

List any disabilities or limitations or any assitive devices (i.e. glasses, hearing aids, or leg/arm braces).

Medications

If your camper needs a prescription or over-the-counter medication while they are at camp...

The medication(s) sent to camp must be in the original container with the correct pharmacy label.
Medication(s) must be in a Ziploc bag labeled with the camper's name. Medication instructions must be clear and readable on the medication container.
The medication container must contain enough medication(s) to last the duration of camp (5 days).
It is your responsibility to visit the camp nurse before camp to discuss the camper's medications.
The camp nurse may request that you drop off medication(s) the Saturday or Sunday before camp to prepare for camp, or the camp nurse will be at camp check-in to receive medications.
The director will notify you for more information on when medications are to be dropped off.

Provide a complete list of medications. Medication name, dosage, time of day to be given, and any other instructions.

Medical Permissions

The following medications will be available to your camper through the camp nurse:

Sunblock, Lip Balm, Antibacterial Ointment, Benadryl (cream/chewable), Anti-Diarrhea, Decongestant, Cough Drops, Visine Eye Drops, Cold Medicine Medication, Insect Repellant, Tylenol, Ibuprofen, allergy medication, stool softener, Antacid, Hydrocortisone Cream, Swimmer's Ear Drops.

I hereby give the RFKC Registered Nurse permission to administer the above-checked non-prescription medication per the instructions of the non-prescription medications, or as otherwise specified.

I authorize the RFKC Registered Nurse to use their best judgment as situations arise, and if in doubt, they can call for verification. I authorize treatment for any injury or illness that occurs at camp, including the administration by the RFKC Registered Nurse for any non-prescription medications. If a physician or hospital service is needed, treatment may be started.

I understand that it is my responsibility as a caregiver to make sure that all the instructions for medications sent to camp, are clear and the necessary dosage is adequately supplied for the duration of camp.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Camp Permissions

I hereby certify that all of the information provided in this application (or in any other accompanying or required documents) is correct, accurate, and complete to the best of my knowledge. I understand that the falsification, misrepresentation, or omission of any facts in these documents may (or will) be cause for the denial of acceptance of the child to attend camp.

The named above minor has my permission to engage in all program activities, except as noted.

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 KIDS camp as legal guardian/social worker/other.

I give my permission for the named above child to attend Royal Family KIDS Camp in the summer of 2026 through the sponsoring church, Mountain Movers Church.

I understand I will not send to camp cameras, phones, money, or snacks for the named above child as these items are needed at the camp.

COVID-19 and its variants remain present. While we follow enhanced sanitation practices, we cannot guarantee that infection will not occur.

By participating in RFKC programs, you voluntarily assume all related risks and agree to release, hold harmless, and not sue WPR, SWTV, and their employees or representatives for any claims or liabilities arising from participation, including claims of negligence, before, during, or after any event.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Person authorized to pick up child from camp?

Phone

Please upload a picture of Child.

Please upload copy of insurance card.