Camp Checklist

Department of Behavioral & Community Health



The following is a checklist of the forms that must be completed and returned to the Dutchess County Department of Behavioral & Community Health, 85 Civic Center Plaza - Suite 106, Poughkeepsie, NY 12601 by April 30, 2018.


  1. Application Packet (includes NYS DOH-3915)
  2. Camp Safety Plan Statement (DC HD-90)  Any and all changes to your plan must be submitted to DBCH 30 days prior to camp orientation for review and approval. A Safety Plan Template is available for your convenience.
  3. Camp Written Plan Checklist (NYS DOH-2040)

    Additional Checklists and Surveys:

    - Amusement Device Survey 2018
    - Buddy System
    - Out of Camp Trips Itinerary / Supplemental Information
    - Written Swimming Pool and Bathing Beach Safety Plan

  4. Children’s Camp Facility & Staff Description Form (NYS DOH-367)
  5. Additional Staff Qualifications Form (NYS DOH-367a)
  6. State Central Register Database Check Form (NYS LDSS-3370) - Must be completed by the Camp Director using the line-by-line instructions.
  7. Prospective Children’s Camp Director Certified Statement Form (NYS DOH-2271) - Must be completed by the Camp Director.

While the above items must be returned by April 30, 2018, other items must be maintained by the camp operator and made available during inspections.

Additional documents and resources may apply to your camp.

All the documents required for a permit to operate a children’s camp are located on this website.

If you have further questions or cannot access the forms, please contact the Department of Behavioral & Community Health at (845) 486-3404.

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A. K. Vaidian, MD, MPH,Commissioner of Behavioral & Community Health A. K. Vaidian, MD, MPH
Commissioner of Behavioral & Community Health
Dutchess County Seal