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All information provided will be accorded confidential treatment and will be used for statistical purposes only; the statistics will be presented in such a manner that no individual person or facility can be identified.

DEPARTMENT OF

HEALTH, EDUCATION AND WELFARE

PUBLIC HEALTH SERVICE

CENTER FOR DISEASE CONTROL - ATLANTA, GA. 30333

CAMP PROFILE

2.

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1-3

Mo.

Day

Yr.

4-6

4.

CAMP ID NUMBER

5.

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7.

TYPE OF CAMP (Check all that apply) 8.

SPONSORSHIP

8

9-10

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9.

NONPROFIT

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10. WHAT IS THE AVERAGE CAMPING FEE PER SESSION?

11.

16-19

20

23

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A. Do camper fees cover the full cost of camp
operations?

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YES
21

- 2

NO

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B. Number of camperships given:

- 3

22

-4

C. Does camp have a sliding fee?

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DIRECTOR

DIRECTOR & STAFF

Other (specify)

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14. DESCRIBE QUALIFICATIONS AND TRAINING FOR PERSONS ACCEPTED AS COUNSELORS

13-14 15-16 17-18

19-20 21-22 23-24

By more than one camping director during the summer season?

15.

IS THE CAMP OPERATED

25 -1

By one camping director during the summer season?

HSM-750-1 (Page 1)

6-73

(Continued on Page 2)

37-569 O-74-26

OMB NO. 68-573043
Approval Expires January 1974

MEDICAL AND EMERGENCY FACILITIES

TRANSPORTATION

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3. INDICATE LICENSES AND CAMP QUALIFICATIONS REQUIRED OF CAMP VEHICLE OPERATORS

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62

(Continued on Page 3)

60

YES

-2

NO

8. ARE APPLICANTS WITH MEDICAL CONDITIONS

ACCEPTED?

63

-1

YES, SPECIFY

-2

NO

ALLOWED CONDITIONS

64

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