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The following forms must be completed in order to obtain a permit to operate a Children’s Camp Permit Application (please return 60 days prior to opening); State Central Register Form for Director – LDSS_3370: The State Central Register Clearance Form for the Director must be submitted to this office. Please remember to include all addresses and the years you lived at each location. Please account for all years since your 18th birthday or 1973. Remember to list all members of your household and if applicable a women’s maiden name. Further information on filling out this form is on the reverse side of the form itself and on the instruction sheet. Extra address and household sheets are also enclosed. The completed signed form must be sent to the office Prospective Children’s Camp Director Certified Statement DOH-2271; This is a NYS Department of Health form. Please complete and return to this office. Children’s Camp Facility and Staff Description _ DOH-367: The completed application must be submitted to the LHD at least 60 days prior to camp operation along with other application forms. A fill-in version of this form is also available. Children’s Camp Additional Staff Qualifications—DOH-367a; The instructions for this form are on the form. You may list some items as pending. You may wish to make copies, so that you will be able to send updated forms to this office. A fill-in version of this form is also available. Contact the office to have this e-mailed to you. NYS Child Safety Act for Children’s Camps; This Act requires Children’s Camp Operators to ascertain whether their prospective employees (all employees) are listed on the Sex Offender Registry prior to hiring them. Written documentation of this search of the registry must be maintained at the camp and be available during health department inspections. Children’s Camp Written Plan Guide DOH 2727 which includes Checklist and 2005 Safety Plan Addendum. The following information is available on the website: Written Statement Brochure; You may copy the brochure Children’s Camps in New York State or use the required language on forms— wording can be found in 7-2.5(p) on page 14 of the code. This information must be provided to all campers; Fact Sheets that describe required certifications for staff, i.e., First Aid, Lifeguard, CPR, Progressive Swimming Instructor and Camp Aquatic Director; ---PAGE BREAK--- (10) Illness, Injury, Abuse, Rabies and Fire report forms. You can use these as guides for reporting any illness or injury, etc. to this department; and (11) Fact sheets which you may find helpful, i.e., information about immunizations, communicable diseases as well as safety equipment. Children’s Camp Written Plans All Children’s Camp Written Plans must be submitted in the approved Written Plan Guide format. Plans need to be reviewed for completeness, changes in staffing, etc. The completed plan should be easy to read, easy to follow and easy to use. The content page should match the contents of the plan. The plan should also include a map of your facility. The new or revised written plan, together with Children’s Camp Written Plan Checklist and the 2005 Safety Plan Addendum, must be submitted to this office for review. The code requires that plan be submitted at least 60 days before the first day of camp operations. Camps with bathing facilities: The Camp Aquatic Director must meet the code requirements for age, experience and certification. In addition, the aquatic director must be on site whenever the bathing facilities are being used. For campers to use a bathing facility, the aquatic director must be at the camp Health Director issues: Responding To Emergencies first aid (or equivalent) is required unless you operate a day camp which is located within 5 minutes of a emergency medical facility and activities do not include aquatics, etc. (programs are limited to minimal physical activity). Nurses are required to have RTE First Aid in order to be the health director. Please check the fact sheets for acceptable CPR courses. Remember that NYS accepts only annual renewals (no 2-year cards). If you plan to use a doctor, nurse or EMT who has an out of state license/ certification, you must get a New York State license/certificate. Information on reciprocity can be found in the Children’s Camps Written Plan Guideline on page11.