Select the camp to attend (age: “as of camp start date”).
RFKC: June 4-8 (ages 7-11)
Bridge: June 16-19 (ages 16-19)
TRAC Girls: June 22-25 (ages 12-15)
TRAC Boys: June 28-July 1 (ages 12-15)
Complete EVERY entry that applies to your child.
T-Shirt Size Child SmallChild MediumChild LargeChild XLargeChild XXLargeAdult SmallAdult MediumAdult LargeAdult XLargeAdult XXLarge
BOYS: Shoe Size
BOYS: Pants Size
GIRLS: Shoe Size
GIRLS: Dress Size
GIRLS: Bra Size
Name of Camper's Case Worker
Case Worker's Phone #
Case Worker's Email Address
Name of Person Camper is Living With
Relationship to CamperBiological ParentAdoptive ParentFoster ParentGroup HomeRelative
Length of Time Camper has been in this Home YEARS MONTHS DAYS
Has camper attended any of our camps? YesNo If "Yes", which one? RFKCTRAC GirlsTRAC BoysBridge
Names and ages of other foster children living in this home
Emergency contact during camp
Please help us get to know this camper better so we can provide positive interactions and activities at camp. Mark ALL the traits that best describe the camper most of the time. socialenergetictalkerhumorousquietseriousplannershyorderlycompetitivedeterminedpeacekeeperathleticobserverperfectionistperformerkindoptimisticnegativeleader
(Mark ALL their interests) video gamesoutdoor activitiesindoor activitiesmoviesshoppingreadingswimminghikingsingingdancingplaying card gamesplaying board gamesactingrappingmusicart/craftsother
List the camper’s favorite sports teams.
Doctor Phone Number
Approved Medical Facility
Emergency Prescription Source
Emergency Prescription Phone Number
*****This information MUST be completed for child to attend camp*****
DTP Series (mm/dd/yyyy)
Tetanus Booster (mm/dd/yyyy)
Measles (live) (mm/dd/yyyy)
Mumps (live) (mm/dd/yyyy)
Polio OPV (sabin) (mm/dd/yyyy)
Tuberculin (TB) (mm/dd/yyyy)
Small Pox (mm/dd/yyyy)
Does the camper have seasonal allergies? YesNoI don't know
Does the camper have food/drug allergies? YesNoI don't know
If "yes" to ANY allergies, please describe.
Is the camper allergic to bees? YesNoI don't know
Does the camper carry an epi pen? YesNoI don't know
Please list ANY of camper's known medical conditions (mental or physical), illnesses or surgeries treated by your doctor.
Does the camper have any physical disabilities or other limitations? YesNoI don't know
If "yes", please describe.
Is the camper diabetic? YesNoI don't know
Does the camper have asthma? YesNoI don't know
Is the camper pregnant? *If "yes", the camper must have a medical release signed by her doctor. YesNoI don't know
Please list ALL medications the camper is currently taking (including OTC drugs).
NOTE: Medications must be in original prescription bottles from prescribing physician.
Any additional information about the child's medication can be added below:
Indicate the degree to which the camper displays the following emotions/behaviors. Please answer honestly.
Negative behaviors do not disqualify a camper from attending camp.
Acting out sexually
Please explain ANY behaviors that occur FREQUENTLY and describe how they are handled.
Is there anything else we should know about the camper in order to better meet their needs while at camp?
I hereby give the nurse from any listed camp permission to administer first aid and the following over-the-counter medication according to manufacturer’s instructions, or as otherwise specified.
I trust the nurse from any listed camp to use his/her best judgment as situations arise, and if in doubt, the nurse can call for verification.
By checking the following box and typing your full name, you agree to the above statement. Please also date the agreement.
I accept the terms stated above.
Electronic Signature (Guardian)
Electronic Signature (Camper, Age 18-19)
List any special instructions (if required):
Insect Repellant YesNo
Lip Balm YesNo
Rash Ointment YesNo
Antiseptic Ointment YesNo
Anti-itch Cream YesNo
Alcohol Wipes YesNo
Cough Syrup YesNo
Cough Drops YesNo
As legal guardian of camper,, I agree that all information provided to Love Fosters Hope is correct and that I approve their participation in any of the camps listed above.
Name (First and Last)
I agree that all information provided to Love Fosters Hope is correct and that I approve my participation in any of the camps listed above.
Please contact us if you have any additional questions.
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