RFKC NWA Camper Application - Summer 2020
Camp Dates for Summer 2020: June 8-12
This form must be completed in one sitting. Please allow 30-45 minutes to complete. The information is vital to the health and well being of the child.
Before beginning application, please make sure you have your child's medical records on hand as you will be required to answer questions about medications, immunizations, and other important information.
Your application will be returned to you if it is not completely filled in. If you have any questions regarding this application, please email us at rfkcnwa@gmail.com. Thank you!
Email address *
Child's Last Name *
Child's First Name *
Preferred Name
Gender *
Birthdate *
MM
/
DD
/
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Address *
Age (at the time of camp) *
Current Emotional Age *
School *
Grade (starting Fall 2020) *
Reading Level *
The child is living with: *
Name(s) of person(s) the child is living with *
Phone Number(s) of person child is living with *
Emergency Contact #1 Name *
Emergency Contact #1 Phone Number(s) *
Emergency Contact #1 Relationship to Camper *
Emergency Contact #2 Name *
Emergency Contact #2 Phone Number(s) *
Emergency Contact #2 Relationship to Camper *
Social Worker Name *
Social Worker Phone Number *
Moved in Foster Placement how many times? *
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.) *
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