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-Kings Team Camp
Adult Shirt Size?
Type of Present Placement:
Relationship to child:
If 'Other' please specify
Date of Present Placement:
Number of placements to date:
Parent/Guardian #2 (If applicable)
Name, Relationship, Email, Phone Number
Parent/Guardian #3 (If applicable)
Name, Relationship, Email, Phone Number
Who will be picking up the Camper at the end of camp?
Please list any adults NOT authorized for pickup?
Emergency Contact (Other then parent or guardian)
Please list the campers siblings, if they currently live together and what their relationship is.
Has the camper previously attended Royal Family Kids Camp?
Has the camper previously attended King's Team?
What types of environments or activities does your camper excel in?
What types of environments or activities does your camper struggle with?
What types of behaviors or activities should we encourage or discourage?
Please list any family circumstances, physical changes, behavioral changes, etc. that your child has experienced in the past year or more that our camp staff and counselors can be informed of in order to effectively meet your child’s needs at camp.
If known, Please share the reason the child was placed in the foster care program:
By typing your name and hitting submit you are agreeing that the information on this application is correct to the best of your knowledge.
*DISCLOSURES & AUTHORIZATIONS
WAIVER, RELEASE, AND INDEMNIFICATION for Southeast Christian Church and Kings Team Camp
I, individually, and in my capacity as foster parent, birth parent, or guardian of any listed child, waive, release, indemnify, and promise not to sue Southeast Christian Church or Kings Team Camp and all of its constituent organizations, agents, ministers, employees, and volunteers (collectively, “Released Parties”) from all demands, claims, or liability, in law or in equity, including the released parties’ own negligence, that have arisen or may arise from this activity, including travel associated with this activity, and that involve any damage, loss, or injury to me, my spouse, any listed child, my property, my spouse’s property, or the property of any listed child. I fully assume the risks associated with participating in this activity. This waiver, release, indemnification, and promise not to sue does not apply to claims of criminal conduct, gross negligence, or intentional acts.
Medical Release for Southeast Christian Church and Kings Team Camp
In case of medical need or injury, I understand that Kings Team Camp will make every reasonable effort to contact me (in the case of an injury to my child) or my emergency contact and his or her caseworker. In the event that I or my emergency backup contact cannot be reached, I authorize Kings Team Camp to arrange for medical services for me or for any listed child. I will be responsible for any medical and related expenses for me or such child. Any provider of care can rely on this Consent as Authority to Treat me or such child as appropriate and to bill me directly for the costs thereof. I understand Kings Team Camp (under the authority of Southeast Christian Church) will hold any medication for such child until needed or scheduled, at which time it is my or such child’s responsibility to inform the staff that the medication is needed. Once at the camp, the child’s medication will be turned over to the Medic on staff at Lutheran Valley Retreat who will be responsible for administering the medication while on their property. I agree that I am responsible for communicating any relevant medical conditions pertaining to me or such child to Kings Team Camp staff using the Medication Administration Form.
I also will inform Kings Team Camp of any changes to medication for the child from the time the application is completed as soon as it happens until the beginning of camp. I will provide only 5 days of medication in the original containers, on the day of camper drop off, July 10, 2022
I understand that Kings Team Camp (under the authority of Southeast Christian Church) may take photographs or video of the listed child in the course of its camp activities. These pictures can be distributed to all campers who attended camp as memories.
Unless otherwise specified these photos and videos may also be used or posted on the camp website.
PHOTOGRAPHY AND VIDEO RELEASE for Southeast Christian Church and Kings Team Camp
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