Camp Director Checklist
To be completed ONLY if camp qualifies under the definition of summer camp or overnight camp
according to NY public health law. If camp does not qualify, please complete “Workshops for Minors
Checklist”
Camp Name _________________________Director/Coordinator_______________________
College/Division _________________________
Department _______________________
Camp Dates (list all) _______________________
Hours of Operation:_________________________
Residential Camp? Yes___________No________
REQUIRED FORMS:
Date
RETURN TO:
M/D/Y
Staff Requirements:
□ NYS Prospective Children's
Camp Director Certified Statement (DOH-2271)
To be completed by Camp Director
______________
Human Resources
Lizanne Zamites
Eastman 5th floor
Fax: 475-7170
Svc Statewide Central Register
Database Check (LDSS-3370)
To be completed by Camp Director
______________
Human Resources
Lizanne Zamites
□ RIT Background Check: Authorization
______________
Human Resources
Lizanne Zamites
□ NYS Office of Children & Family
(Sex offender registry check)
To be completed by each volunteer and staff member
□ Camp Medical Director
______________
Must be hired with appropriate credentials
See Risk Mgt website for specific requirements.
□ Camp Aquatics Director
______________
Must be hired with appropriate credentials if using GFH pool.
See Risk Mgt website for specific requirements
Permit requirements:
□ NYS Dept of Health Children's Camp
Facility & Staff Description (DOH-367 & DOH-367a) _______________
To be completed by Camp
Director
□ NYS Dept of Health
Staffing Guidelines
________________
N/A-Info only
________________
EH&S – Jody Nolan
Grace Watson
□ RIT Camps & Workshops Safety Plan
(Provided by EH&S)
□ CAMP BROCHURE
(Provided by EH&S)
__________________
Must also be distributed to parents during registration process
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Available on Risk Mgt
website
Insurance requirements:
□ Camps & Workshops Accident Policy
Enrollment Form
______________ Risk Management-Melinda Ward
Eastman 4th floor
Fax: 475-7950
Registration requirements:
□ RIT Agreement to Participate (waiver)
______________ Must be kept on file for 6 years
□ RIT Medical and Health Insurance Information and
Immunization History Forms
______________ Must be kept on file for 6 years
Registration requirements (cont’d):
□ RIT Medication Form and
Medication Permission Forms
(if necessary)
______________ Must be kept on file for 6 years.
Hosting department is required to maintain in a secure location for a period of 6 years after conclusion of
camp:
 Current confidential medical history including proof of required immunizations.
 Health screenings and medication plans by qualified medical staff
 Release Agreement required for each participant (signed by parent/guardian)
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