2025 Royal Family KIDS Camp

Important Information for Parents & Guardians
Camp Dates: June 9-13, 2025
Location: To be provided upon acceptance. (Drop off in Orange, CA- 7:30am on Monday and 2-3pm on Friday)
Application Deadline: Applications must be fully completed for consideration.
Contact for Questions: Yuli Kizler - Call/Text 951-349-7860

You may view this application in Spanish by selecting the language option at the top right corner.

Application Instructions
Please fill out this form completely. The information provided is vital to the well-being and safety of your child during camp. Incomplete applications may be returned for completion.

You will need your childs medical insurance info and an Identifyable picture of them.

Who Should Complete This Form?
This form should be completed by a parent, guardian, or social worker who is legally responsible for the child.

Child's Full Name

First NameLast Name

Child's Preferred Name

Child Identifiable Picture (for counselors to find/identify them)*

Please submit a clear and current picture of child

Gender

Birthday

Age During Camp

What is your child's emotional age/maturity (if applicable)?

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

School Name

Grade Level

Reading Level

Child is currently living with-

Name of primary guardian/caregiver

Guardians Email-

example@example.com

Best Guardian Contact Number for the purposes of this application

Please enter a valid phone number.

Emergency Contact Name

First NameLast Name

Relationship to Child

Emergency Contact Number

Please enter a valid phone number.

Social Worker Name

First NameLast Name

Social Worker Phone Number

Please enter a valid phone number.

Social Worker Email

example@example.com

Has the child been in foster care?

YesNo

Has the child lived with someone other than biological parents due to special circumstances?

YesNo

If yes, please explain: (Examples: living with relatives due to parental incarceration, homelessness, domestic violence, parental illness, or other significant family disruptions.)

Why would this camp be especially important for your child?(Please describe how camp can support their growth and healing.)

Does your child exhibit any of the following behaviors? (Check all that apply)

Does your child struggle with nighttime potty training?

YesNoSometimes

Has your child been diagnosed with a behavioral or learning disability?

YesNoUnclear

Please explain here

Has your child been diagnosed with autism spectrum disorder?

YesNo

If yes, what accommodations or mentor preferences have helped them thrive?

Has your child attended a Royal Family Kids Camp before?

YesNo

If yes, where?

What was their experience?

Favorite activities or hobbies

Clothing Size for Shirt/Sweater

Pants Size

Shoe Size

Favorite Color

Gift Ideas

Does your child have any known allergies?

Does your child have any medical conditions, disabilities, or physical limitations?

Is your child currently taking any medication?

YesNo

If yes, please list medication(s) and dosage

Doctor’s Name

Doctor’s Contact Number

Please upload a picture of their medical/insurance card

*(All medications must be in their original containers with pharmacy labels. The camp nurse will administer all medications.)*

DTP Series/Booster

Tetanus Booster

Polio OPV

Mumps/Measles Vaccine

Tuberculin (TB) Test

Others (please specify)

Medical Consent: I understand that it is my responsibility to provide accurate medical information and sufficient medication for my child’s stay. I authorize RFKC’s nurse to administer necessary medications.

Agree

Participation Waiver: I acknowledge that camp activities, including swimming, climbing, and outdoor games, have inherent risks, and I release RFKC and its partners from liability in case of injury.

Agree

Photo/Video Release: I give permission for my child’s photos/videos to be used in RFKC promotional materials. Their faces will NOT be revealed.

Agree

Transportation is NOT provided on Monday and Friday. Guardians must confirm a transportation plan by June 1st. If there is no confirmed transportation, the child will not be able to attend camp unless plans are arranged. In case of an emergency, guardians must arrange to pick up their child FROM the campsite.

Agree

Parent/Guardian Signature

2025 Royal Family KIDS Camp

Camper Information

Living Arrangements

Emergency Contacts

Social Worker

Foster Care and Special Circumstances

Behavioral & Emotional Considerations

Camper Preferences

Medical Information & Health History

Immunization History (If known)

Parent/Guardian Consent & Waivers