GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES 
Department of Human Services 
Office of Child Care & Regulatory Services 
Children’s Camp Registration 
 
□ 
3011 Golden Rock 
Christiansted 
St. Croix, VI  00820-4355 
Phone: (340)773-2323 
Fax:  (340)773-6121 
□ 
Knud Hansen Complex Bldg. A 
1303 Hospital Ground 
St. Thomas, VI  00802 
Phone: (340)774-0930 
Fax:  (340)774-9702 
 
I. Name of Camp:  
 
 
 
 
 
 
 Telephone:   
 
 
Physical Address of Camp:  
 
 
 
 
 
 
 
 
 
Mailing Address of Camp:  
 
 
 
 
 
 
 
 
 
Email address:  
 
 
 
 Directions to Facility:  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Check Type of Facility: Church  Commercial     Corporation      Partnership 
 
 
 
 
Proprietorship     Public Agency 
II. Name of Operator/Director:   
 
 
 
 
 
  
 
 
 
       
 
 
  Last                 First               Middle        
      Home/Cell Phone 
Home & Mailing Address:  
 
 
 
 
 
 
 
 
 
 
III. Check Type of Operation: Full Day     Half Day     Overnight     Other (Specify) 
Hours of Operation: From: 
 
 
 
 To:  
 
 
 
 
Days Per Week: Sunday  Monday  Tuesday Wednesday  Thursday  Friday  Sat 
Duration of Camp, (Month/Date): From:  
 
 
 To:  
 
 
 
 
 
Please indicate any variations in established fee, for example, more than one child in the same family. 
Camp Monthly Fee 
Registration Fee 
Insurance 
 
 
 
 
 
 
 
      Description of Services/Program: Cultural     Sport     Recreational     Partnership 
 
 
 
 
      
 Other  
 
 
 
 
 
 
      Proposed Maximum Capacity:  
      Total number of children (include children of operator & staff)   
 
  
        
   
 Minimum Age 
 
 Maximum Age 
        
 
 Full-time Staff 
 
 Part-time Staff 
 
IV. I certify that I have not been convicted of a crime involving child abuse, child neglect or moral 
turpitude and have not hired any person with aforementioned conviction to work at the camp. 
 
I have received a copy of the regulations for children’s camp and agree to operate my camp in 
accordance with these regulations. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                                                         Signature                                     Date 
 
Note: Please attach the flyer and schedule of activities for your camp.  
(Children’s Camp Registration Forms should be completed by an operator or director who have a current license or certificate.) Revised 6/29/20