All American Purchasing Group

OVERNIGHT CAMP SUPPLEMENT

Program Administrator

Producer

Applicant:

Bob McCloskey Insurance

P.O. Box 511, 76 Main Street

Matawan, NJ 07747

1-800-445-3126

fax (732)583-9610

Name: ______________________________

Address : ___________________________

____________________________________

Phone: _____________________________

1.   Director’s # of years’ experience in camp management:

2.   Are national criminal background checks done on all staff & volunteers (new and current)?

3.   Are any activities unsupervised (if yes, describe all)?

4.   Is at least 1 person over the age of 25 on-site all night?

5.   Are counselors/group leaders at least 18 years of age?

6.   What is the ratio of instructor/supervisor to student/camper?

7.   Describe the sleeping arrangements and facilities, including supervision:

8.   Describe the physical characteristics of the camp (include distance to nearest non-related facility):

9.   Is there any water-related activity or water hazard (explain)?

10.   Provide details of each counselor’s training, including First Aid training:

11.  Attach promotional brochures and a detailed list of all camp activities.

12.  Is the camp classified as a “special needs” camp?

(for persons with special needs, due to mental or physical handicap or medical condition)

13.  Is the camp coed?

14.  Describe any overlapping or concurrent camps, seminars or tournaments at the same location:

15.  Remarks:

Applicant

Date