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royal_family_kids_camp_volusia

Royal Family Kids Camp

Camper Registration Form

YOUR INFORMATION
BASIC CAMPER'S INFORMATION
Camper's Sex
The Camper is Living With:
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CAMPER'S EMOTIONAL/BEHAVIORAL HISTORY
Aggressiveness
Night Terrors
Bedwetting
Nightmares
Biting
Runs Away
Eating Disorders
Sexual Acting Out
Hyperactive
Steals
Learning Disabilities
Tantrums
Lying
Withdrawn
Does the Camper have a "Care Precaution Plan?"
CAMPER'S DETAILS
Camper's Swimmig Ability
Camper Has Learning Disability
Has the Camper Attended a Royal Family Kids Camp Before?
Camper's T-Shirt Size
CAMPER'S HEALTH HISTORY
Camper Has An Eating Disorder
Camper Limitations
Please indicate date of illness, severity, complications, or any residual impairments of the following:
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.
Is the Camper Taking Any Medications?
I hereby authorize RFKC’s nurse to administer the above medication(s)
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.  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.

I give my permission for the above-listed child to attend the Royal Family Kids’ Camp in the summer of 2024 through OneFamily.
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.

I trust the RFKC Registered Nurse to use her best judgment as situations arise, and if in doubt, he/she can call for verification.

Please check YES or NO for the medications listed below.  This form must be completely filled out by the primary caregiver who signs below, or the camper may not attend camp.
Insect Repellant
Ras Ointment
Band-Aids
Cough Syrup
Antihistamine
Lip Balm
Tylenol
Anti-Itch Cream
Cough Drops
Ipecac Syrup
Sunblock
Antiseptic Ointment
Hydrogen Peroxide
Decongestant
Please do not send cameras, money, or any electronic devices with the camper. These items are not needed at camp.

Thanks for registering your camper!

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