Royal Family KIDS camp template

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2025 Royal Family KIDS Camp
Welcome! Thank you for registering your child to attend ROYAL FAMILY KIDS CAMP, sponsored by FTC Refuge OC. We are excited to provide a life-changing camp experience for children who have faced adversity, offering them a safe, loving, and joyful environment.

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.

Camper Information
Child's Full Name
Magdalena Ault
Child's Preferred Name
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Child Identifiable Picture (for counselors to find/identify them)
Item - 74971 Royal Family KIDS camp template 0
Gender
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Birthday
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Age During Camp
8
What is your child's emotional age/maturity (if applicable)?
8
Home Address
1 Summit Pass, 3 Beilfuss Drive
Springfield, Illinois, 62705
United States
School Name
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Grade Level
8
Reading Level
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Living Arrangements
Child is currently living with-
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Name of primary guardian/caregiver
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Best Guardian Contact Number for the purposes of this application
+78 (70) 248-2878
Emergency Contacts
Emergency Contact Name
Magdalena Ault
Relationship to Child
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Emergency Contact Number
+78 (70) 248-2878
Social Worker
Social Worker Name
Magdalena Ault
Social Worker Phone Number
+78 (70) 248-2878
Foster Care and Special Circumstances
Has the child been
in foster care?
Optio
n 2
Has the child lived with someone other than biological parents due to special circumstances?
Option 2
If yes, please explain: (Examples: living with relatives due to parental incarceration, homelessness, domestic violence, parental illness, or other significant family disruptions.)
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Why would this camp be especially important for your child?(Please describe how camp can support their growth and healing.)
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Behavioral & Emotional Considerations
(This information helps us provide the best possible care and assign the right camp-counselors.)
Does your child exhibit any of the following behaviors? (Check all that apply)
Option 2
Does your child struggle with nighttime potty training?
Option 2
Has your child been diagnosed with a behavioral or learning disability?
Option 2
Please explain here
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Has your child been diagnosed with autism spectrum disorder?
Option 2
If yes, what accommodations or mentor preferences have helped them thrive?
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Camper Preferences
Has your child attended a Royal Family Kids Camp before?
Option 2
If yes, where?
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What was their experience?
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Favorite activities or hobbies
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Clothing Size for Shirt/Sweater
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Pants Size
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Shoe Size
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Favorite Color
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Gift Ideas
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Medical Information & Health History
Does your child have any known allergies?
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Does your child have any medical conditions, disabilities, or physical limitations?
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Is your child currently taking any medication?
Option 2
If yes, please list medication(s) and dosage
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Doctor’s Name
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Doctor’s Contact Number
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*(All medications must be in their original containers with pharmacy labels. The camp nurse will administer all medications.)*

Immunization History (If known)
DTP Series/Booster
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Tetanus Booster
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Polio OPV
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Mumps/Measles Vaccine
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Tuberculin (TB) Te
st
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Others (please specify)
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Parent/Guardian Consent & Waivers
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.
Option 2
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.
Option 2
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.
Option 2
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.
Option 2
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