DO NOT PRINT THIS APPLICATION...It must be filled out and submitted online. If you have problems completing the form, please contact us directly. The application may take 20-30 minutes to complete and you will need to attach a .jpg photo to complete it. Color head shots are the most helpful. Applications are processed on a first come, first served basis. YOU WILL HEAR BACK FROM US VIA EMAIL within the week. There is no fee to attend camp. All campers must be between the ages of 7-11 at the time of camp: June 22rd, 2026. Children younger or older will be accepted on a case by case basis, space permitting. We work hard all year to make this camp happen and we want a full camp. Please be courteous and contact us if circumstances change and your child is unable to attend.
Questions?
IF YOU HAVE QUESTIONS about available space, if your child qualifies for camp, or have other questions or concerns about RFKC: Please contact the RFKC camp director, Marc Biscornet at (803) 526-4761 or deputy director Chuck Peterson at 843-568-3352
Child's Name
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First Name
Last Name
Name of Person Filling Out This Application
*
First Name
Last Name
Relationship To Child
*
Caseworker
Caregiver
Other
Child's Information
Preferred Name (if child has one)
If child is a returning camper and had a DIFFERENT NAME LAST YEAR, please let us know!
First Name
Last Name
Gender
*
Male
Female
Birth date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
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9
10
11
12
13
14
15
16
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18
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20
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22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
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1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Age at Time of Camp (June 22, 2026) *If the birth year is before June 22, 2014 or after June 22, 2020, then they are not in the correct age range.
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6 years old (by exception)
7 years old
8 years old
9 years old
10 years old
11 years old
12 years old (by exception)
Emotional Age
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Very mature
About normal
Immature
Child's T-Shirt Size
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Child Medium
Child Large
Adult Medium
Adult Large
Adult Extra Large
Is this child a returning RFKC Camper?
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Yes
No
Uncertain
Siblings of Child Applying to RFKC This Summer
If siblings of this child will ALSO be applying to come to camp, please provide their name so we can try and get all siblings to camp this summer. Please complete a separate application for each child. Multiple children listed on one application may be missed.
If a sibling of this child is applying to camp, please tell us who that is.
First Name
Last Name
This sibling is a...
Biological Sibling
Foster Sibling
Sibling in Adoptive Family
If 2nd sibling is applying to camp, please tell us who that is. You must fill out a separate application for each child.
First Name
Last Name
2nd sibling is a...
Biological Sibling
Foster Sibling
Sibling in Adoptive Family
If 3rd sibling is applying to camp, please tell us who that is.
First Name
Last Name
3rd sibling is a...
Biological Sibling
Foster Sibling
Sibling in Adoptive Family
If 4th sibling is applying to camp, please tell us who that is.
First Name
Last Name
4th sibling is a...
Biological Sibling
Foster Sibling
Sibling in Adoptive Family
Parent/Guardian Information
This home is best described as...
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Foster Home
Adoptive Parents
Group Home
Kinship
Biological Parent(s)
Other
At time of camp, how long will this child have been living in current home?
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less than 4 months
4-6 months
6-11 months
1-2 years
3+ years
Other
Total # of foster or residential placement for the child (including current home).
1
2
3
4
5
6
7
8
9
Parent or Legal Guardian #1
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First Name
Last Name
Relationship to Child
*
Best Phone Number
*
-
Area Code
Phone Number
Parent/Guardian #1 Email Address
Parent or Legal Guardian #2
First Name
Last Name
Relationship to Child
Parent or Legal Guardian #2 Best Phone Number
-
Area Code
Phone Number
Parent/Guardian #2 Email Address
Address
Street Address
Street Address Line 2
City
State
Zip Code
Authorized to Pick Child Up From Camp on Friday, June 27th
Who (other than caseworker or caregiver ) is an authorized adult that may pick this child up after camp June 27? **Government ID required**
First Name
Last Name
Cell Number for Authorized Adult
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Area Code
Phone Number
SECOND authorized adult. **Government ID required**
First Name
Last Name
Cell Number For Authorized Adult
-
Area Code
Phone Number
Caseworker/Child Placement Agency Information
Caseworker Name
*
First Name
Last Name
Caseworker Email
*
Caseworker Agency
*
Example: Charleston Co. Berkeley Co., Bair, Mentor, Lifeline Child
Caseworker Phone 1
*
-
Area Code
Phone Number
Caseworker Phone 2
-
Area Code
Phone Number
Caseworker's Supervisor
*
First Name
Last Name
Supervisor Email
Supervisor Phone Number (not intake #)
*
-
Area Code
Phone Number
Guardian Ad Litem
First Name
Last Name
GAL Email
example@example.com
GAL Phone Number
-
Area Code
Phone Number
Background/Behavior Information
Please fill this out to the best of your ability. All information shared is confidential. We as RFKC staff want to make sure this child as well as other campers have a safe, healthy, fun time at camp. This information is extremely helpful and is only shared with camp staff on a "need to know" basis.
Why would this child's attendance at RFKC be important? Why would you like to see him or her attend camp?
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How often does this child wet the bed at night?
Never wets the bed
Rarely wets the bed
Frequently wets the bed
Do not know about bed wetting
If child does wet the bed, please explain (i.e. wears pull-ups, don't drink liquids after certain time, just need to be aware, etc.)
What bed time strategies do you use to help the child get to bed or fall asleep?
Does this child display aggressive behavior?
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Never aggressive
Rarely aggressive
Frequently aggressive
Not observed
Please explain aggressive behavior. (What may trigger aggressive behavior or to whom child is aggressive.)
What strategies or techniques have you successfully used to deal with aggressive behavior?
Does the child deal with any of the following eating disorders or issues around food?
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Anorexia
Bulimia
Overeating/Gorging
No Eating Disorders
Hording or Stealing Food
Do Not Know Of Any Eating Disorders
Other
If this child does have an eating disorder - or has other issues around food we should know about - please explain. Do they have any food allergies.
How would you describe this child's demeanor?
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Very calm
Somewhat hyperactive
Frequently hyperactive
Please let us know if any of the following learning difficulties exist for this child.
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Hearing impairment
Vision impairment (that would affect time at camp)
Reading difficulties
Don't know about learning difficulties
Other
How often does this child lie?
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Never lies
Rarely lies
Frequently lies
Can't tell lies from truth
Please let us know how often this child has nightmares.
*
Never or rarely has nightmares
Frequently has nightmares
Don't yet know about nightmares
Please let us know how often this child has night terrors.
*
Never or rarely has night terrors
Frequently has night terrors
Don't yet know about night terrors
Please let us know how to calm this child or prevent nightmares.
Please let us know how often this child runs away from a situation or from home.
*
Never or rarely runs away
Frequently runs away
Don't yet know if child runs away
Please let us know if - or how - this child may act out sexually.
*
Does not act out sexually
Do not know if child sexually acts out
Touches self
Touches other children
Flirts or pays inappropriate attention to adults
If this child does act out sexually, please explain.
How often does this child steal?
*
Never or rarely steals
Frequently steals
Do not know about stealing yet
Know of stealing in the past, but not currently
How often does this child have tantrums or anger issues?
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Never or rarely has tantrums or anger issues
Frequently has tantrums or anger issues
Don't know about tantrums or anger yet.
If this child does have tantrums or anger issues that are beyond normal childhood frustrations, please describe successful strategies or techniques you have used.
Has this child been diagnosed with autism or do you suspect they may be on the spectrum? This is NOT a disqualifier for camp; however, it will warrant a phone call.
*
Is the child in a mainstream classroom?
*
Yes
No
Partial
With support staff
How often does this child withdraw?
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Never withdrawn
Rarely withdrawn
Frequently withdrawn
Don't know about how often child withdraws yet
HISTORY/STORY
Please share this child's history or story so we can understand how to give him or her an even MORE amazing week at camp!
** Please tell us about this child's history or story. What situations may have been challenging for this child before living in your home? What circumstances is this child dealing with?
*
If this child attended Royal Family KIDS' Camp in the past, what did he or she like about it? What positive changes or behaviors did you see upon their return home?
Please tell us what this child's interests, passions, loves, etc. are so our Staff can make camp even more special! (i.e. Loves sports, interested in horses, favorite color is purple...whatever!) This information will help our counselors and staff connect more quickly. Simple things can make a big difference.
*
Medical History + Prescription Medication Information
List all known allergies to food, plants, medications, animals, etc. (If none, type "none"
Weight - Children's medications are frequently determined by weight. This information will help our nurses.
Please tell us what this child's interests, passions, loves, etc. are so our Staff can make camp even more special! (i.e. Loves sports, interested in horses, favorite color is purple...whatever!) This information will help our counselors and staff connect more quickly. Simple things can make a big difference.
This child's swimming ability is...
*
Poor Swimming Ability
Good or excellent swimming Ability
Do Not Know Swimming Ability
Illnesses and Medical Complications Past or Present (check all that apply)
*
Respiratory Problems
Seasonal Allergies
Food Allergies
Medicine Allergies
Topical Allergies (lotion, sunscreen, etc.)
Dizzy Spells and/or Fainting
Back Problems
Seizure Disorders
Anaphylactic Shock
Balance Problems
Asthma
ADD or ADHD
Hypoglycemia
Heart or Circulation Problems
Pulmonary Edema
Type 1 Diabetes
Type 2 Diabetes
Insect Bite Allergies (i.e. mosquitoes, bees, ect.)
Recent Surgery
Recent Broken Bones
NONE
Other
Please explain each medical issue you checked above. (If you did not check anything, please type DOES NOT APPLY."
What specific activities should be DISCOURAGED for medical reasons while at camp?
NON-PRESCRIPTION Medications / Treatments: that you approve the medical team to administer at camp.
*
All of the Below
Sunblock/Sunscreen
Insect Repellent
Lip Balm
Rash Ointment
Tylenol
Advil
Antiseptic Ointment
Bandaids
Anti-Itch Cream
Hydrogen Peroxide
Rubbing Alcohol
Cough Syrup
Cough Drops
Decongestant
Antihistamine
Other
Prescription & Over-the-Counter Medications
If your child is NOT taking any prescription or over-the-counter medications, vitamins, or inhalers to camp, please type "NONE" in each of the boxes.
I understand that it is my responsibility as a caregiver to ensure that all instructions are clear and that the necessary dosage is adequately supplied for the duration of camp (Monday, June 22, to Friday, June 26, 2026.) I authorize RFKC medical staff to administer the medications.
*
Yes, I understand that sharing medical info, medications, and dosages are my responsibility. I will bring medications in their original containers.
No, I do not understand that sharing medical info, medications, and dosages are my responsibility.
Prescription or Over-the-Counter Medication #1
Prescription Medication 1: Reason for taking, DOSAGE, and Time(s) of Day to Administer
How long as child been taking Medication 1? (Be specific.)
Prescription or Over-the-Counter Medication #2
Medication 2: Reason for taking, DOSAGE, and Time(s) of Day to Administer (Be specific.)
How long has child been taking Medication #2? (Be specific.)
Prescription or Over-the-Counter Medication #3
Medication 3: Reason for taking, DOSAGE, and Time(s) of Day to Administer (Be specific.)
How long as child been taking Medication #3? (Be specific.)
Prescription or Over-the-Counter Medication #4
Medication #4: Reason for taking, DOSAGE, and Time(s) of Day to Administer (Be specific.)
How long as child been taking Medication #4? (Be specific.)
Prescription or Over-the-Counter Medication #5
Medication #5: Reason for taking, DOSAGE, and Time(s) of Day to Administer (Be specific.)
How long has child been taking Medication #5? (Be specific.)
Additional information we need to know about the above prescription drugs, vitamins, or over-the-counter medications sent to camp - or - additional meds if any.
Prescribing Doctor
First Name
Last Name
Doctor's Phone Number
-
Area Code
Phone Number
Please upload a recent photo of this child. Upload a JPG ONLY...do NOT upload a PDF or other file type **. You will not be able to upload a photo larger than 1 MB (or 1024 KB) in size.
*
Upload a File
Cancel
of
Have you coordinated with DSS? Are they aware of camp and have they ensured there are no scheduling conflicts?
*
Caseworker is aware of camp and has assured me of no scheduling conflicts
Caseworker is aware of camp but has not confirmed there are no scheduling issues
Caseworker has not been notified
Our child does not currently have a caseworker
Permission
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 Family 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 minor named in this application to attend Royal Family KIDS Camp in the summer of 2024 through Summerville Calvary Chapel.
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
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PERMISSION TO TRANSPORT
The above mentioned organizations are hereby authorized to transport said minor by charter bus from the registration location in Summerville, SC on Monday, June 22rd and transport the minor from the campground to the pick-up location on Friday, June 26th. They are also authorized to transport to a hospital in the event of a non-serious injury. I understand that if I should, for any reason, desire to retrieve said minor from camp before Friday, June 26th, 2026, I will first be required to make arrangements with the directors and meet at an agreed upon location. I, by my signature, release Summerville Calvary Chapel, Royal Family Kids inc, and any other involved parties from liability in relation to travel to and from camp.
Name
*
First Name
Last Name
Signature
Date
*
-
Month
-
Day
Year
Date Picker Icon
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