RFKC Camper Application 2017

RFKC Camper Application 2017

camper application for Royal Family Kids Camp. Please edit information before publishing Form Preview
RFKC Camper Application 2017
  • DO NOT PRINT THIS APPLICATION...MUST BE FILLED OUT AND SUBMITTED ONLINE. THE APPLICATION WILL TAKE 20-30 MINUTES TO COMPLETE. YOU WILL NEED TO ATTACH AN IMMUNIZATION RECORD AND A JPG PHOTO OF THIS CHILD TO COMPLETE THE APPLICATION. ALL APPLICATIONS MUST BE RECEIVED BY APRIL 14TH. YOU WILL HEAR BACK FROM US VIA EMAIL BY MAY 1ST. There is no fee to attend camp. All Campers must be between the ages of 6-12 at the time of camp: June 19th- June 23rd, 2017.

    Note: We will be launching Teen Reach Adventure Camp this December (Dec. 28-31, 2017) for ages 13-16. If you know a teen you feel would benefit from this, please send us a quick email to info@onehopela.org and we will follow up with you in the fall.
  • Questions?

    IF YOU HAVE QUESTIONS about available space, if your child qualifies for camp, or have other questions or concerns about RFKC: Please contact the RFK Child Placement Coordinator Sylvia Gray at sylvia.gray.DCFS@la.gov

  • Child's Information

  • Siblings of Child Applying to RFKC This Summer

    If siblings of this child will ALSO be applying to come to camp, please provide their info so we can try and get all siblings to camp this summer.
  • Parent/Guardian Information



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  • Authorized to Pick Child Up From Camp on Friday, June 23

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  • Caseworker/Child Placement Agency Information

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  • Background/Behavior Information

    Please fill this out to the best of your ability. All information shared is confidential. We as RFKC staff want to make sure this child as well as other campers have a safe, healthy, fun time at camp. This information is extremely helpful and is only shared with camp staff on a "need to know" basis.


  • HISTORY/STORY: Please share this child's history or story so we can understand how to give him or her an even MORE amazing week at camp!

  • Medical History + Prescription Medication Information



  • Prescription & Over-the-Counter Medications

    If your child is NOT taking any prescription or over-the-counter medications, vitamins, or inhalers to camp, please type "NONE" in each of the boxes.
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  • Permission

    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. The 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 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 as legal guardian/social worker/other. I give my permission for the minor named in this application to attend Royal Family KIDS Camp in the summer of 2017 through The Harbor Church.
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  • PERMISSION TO TRANSPORT:

    The above mentioned organizations are hereby authorized to transport said minor by charter bus from the registration location in Hammond, LA on Monday, June 19th, 2017 and transport the minor from the campground to the pick-up location on Friday, June, 23rd. I understand that if I should, for any reason, desire to retrieve said minor from camp before Friday, June 23rd, 2017, I will first be required to make arrangements with the directors and meet at an agreed upon location. I, by my signature, release The Harbor Church, Royal Family Kids inc, and any other involved parties from liability in relation to travel to and from camp.
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