Children's Camp Additional Staff Qualifications. DOH-367a - Children's Camp Additional Staff Qualifications - health ny 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Facility Name and Facility Code at the top of the form. Ensure that you accurately input the Date Open and Date Close for your camp.
3. For each staff member, fill in their name, provider, course title, and issue date under the Progressive Swimming Instructor (PSI) section. This is crucial for assessing camper swimming abilities.
4. In the Lifeguard Certification section, list each lifeguard's name and date of birth. Include their certification details and ensure they meet the required qualifications as per state regulations.
5. Complete the Additional First Aid and CPR Staff section by providing names and dates of birth for staff members who hold these certifications. Remember to adhere to the minimum staffing requirements based on camper numbers.
6. Fill out Counselor Data by indicating the number of counselors proposed for your camp session, categorized by age group and gender.
7. If applicable, provide details for any Riflery Instructors including their name, date of birth, certification, and issue date.
8. Finally, certify that all information provided is true by signing at the bottom of the form with your printed name, title, and date.

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