Camper Application

Camper Application

Application for all campers Form Preview
  • Sponsored by Christian Life Center

    1009 Mission St, Santa Cruz CA 95060~(530) 617-1778 www.santacruz.royalfamilykids.org
  • 2018 Camp Dates: June10-15

  • Camper Application

    For children in the Foster Care system ages 7-11 years old APPLICATIONS DUE NO LATER THAN May 1st
  • Any application not fully completed will be returned and the child will be at risk of not being accepted to camp.

  • Camper's Details

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    Pick a Date


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  • Authorized to Pick up Camper on Friday, June 15

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  • Siblings

  • Camper's Emotional/Behavioral History

  • Campers Health History

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  • Prescription Medication - all medication sent to camp must be in original container with the pharmacy label on it

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  • 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 medication from June 10 - 15, 2018. Medications must come in the original prescription bottle with the correct dosage on the label. Be prepared to review the medications and prescriptions with the camp nurses.
  • Medical Release Form

    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. I do hereby authorize the directors of Royal Family KIDS Camp Santa Cruz 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 or surgeon, licensed under the provision of the Medicine 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 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 Santa Cruz as legal through Christian Life Center.

  • Permission to administer over-the counter medications

    I hereby authorize the Royal Family KIDS Camp Santa Cruz nurses permission to administer the following products according to manufacturer's instructions, or as otherwise specified. I trust the RFK's nurses to use their professional judgement as situations arise, and if in doubt contact the person listed below for verification.
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  • Please check which of the medications listed below should NOT be administered by Royal Family KIDS Camp nurses:

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