BASIC CAMPER'S INFORMATION Please explain any unusual family circumstances that make camp especially important for the child, for example: recent crisis, being moved in foster placement, severe economic needs, etc.
CAMPER'S EMOTIONAL/BEHAVIORAL HISTORY Please explain the results from the Camper’s Emotional and Behavioral History from the previous section.
Wishlist for Three (3) Birthday Gifts:
Please indicate date of illness, severity, complications, or any residual impairments of the following: Please explain the results from the Camper’s Emotional and Behavioral History from the previous section.
CAMPER'S IMMUNIZATION HISTORY
Please fill in dates of basic immunizations and most recent booster as best as you can.
PRESCRIPTION MEDICATIONS All medication sent to camp must be in the original container with the pharmacy label on it. Please add any other comments related to HEALTH and MEDICATIONS. I understand that it is my responsibility as a 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 RFKC’s nurse to administer the above medication(s)
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 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.
PERMISSION TO ADMINISTER OTC MEDICATION
I hereby give the Royal Family Kids’ Camp Registered Nurse permission to administer the following products according to the manufacturer’s instructions or as otherwise specified. Any additional information you think our team should be aware of:
Please do not send cameras, money, or any electronic devices with the camper. These items are not needed at camp. Register
Thanks for registering your camper!
