Staff Forms
Please Download and Fill Out The Forms Below
In compliance with the Department of Health, the forms below are mandatory and essential for the well-being and safety of our camp. These forms MUST be completed and signed prior to the first day of camp. If Park Shore does not have the completed and signed forms, we will not be able to permit you to start camp until they are signed and received. According to NYS Department of Health Regulations and the Suffolk County Department of Health, all staff members at day and resident camps must have on file a recently completed Health form with important contact information, documentation of physical exam (within the past 12 months), a documented vaccination record and written verification from your health care provider that you may attend and participate in all camp activities or a statement of activity restrictions, if pertinent. We ask that you supply us with a completed Health Form which includes contact information, your physician’s signature, stamp, and evidence of physical exam. We appreciate your immediate attention to this matter and look forward to an amazing fun-filled summer. Thank you for your cooperation. If you have any questions, please call our office at (631) 499-8580.
Pre-Camp Health Screening Form
Health Forms
2022 Medical Authorization Form
2022 Physical Exam & Immunization Form
How to Submit Forms
- FAX: 631-499-6917
- Email: dawn@parkshoredaycamp.com
- Drop Off
LONG ISLAND SUMMER DAY CAMP PROVIDING AMAZING CAMP EXPERIENCES FOR OVER 65 YEARS
Visit Us
450 Deer Park Road
Dix Hills, NY 11746
Tour Hours
M-F: 10am - 4pm
S-S: 11am - 2pm (February - June)