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Camp Checklist

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 30th of the current camp year.

Additional forms and resources may apply to your camp.

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




  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:

  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.