Skip to content

Summer Camp Survey

Camp/Center Name
Director's Name
Facility Address
City, ZIP
Phone
Secondary Phone
E-mail
Web Site
2 Major Cross-Streets by Address
Mailing Address (if different from above)
City, ZIP
Preschool (2-5 yr.)
License #
Effective Date
Capacity

Toddler Option

License #
Effective Date
Capacity

School Age Option

License #
Effective Date
Capacity
School Age (Kinders & Older)
License #
Effective Date
Capacity
Is your Summer Program Exempt from Licensing?
Maximum # of Children you will serve in your program:
Ages of Children you will serve
Do you provide transportation for school age children?
Are you located on the school grounds?
List schools served
School District
Language(s) that staff speaks
Vacancies (child care openings)
Total #
Preschool (2 yr. - 5 yr. 11 mon.)
School Age (6 yr. & up)
Fees

Toddlers

Full-Time Costs
Per Week
Part-Time Cost
Per Week
Comments

Preschool

Full-Time Costs
Per Week
Part-Time Cost
Per Week
Comments

School Age

Full-Time Costs
Per Week
Part-Time Cost
Per Week
Comments

Kindergarteners

Full-Time Costs
Per Week
Part-Time Cost
Per Week
Comments
Fee waivers & Discounts: (Check all that apply)
Other
Days Open for Camp: (Check all that apply)

Hours

Open
Close
Date Summer Camp sessions begin
Type of Schedule: (Check all that apply)
Check all that Apply to your Summer Camp
Meals Served
Program
Philosophy
Education

Special Needs

Experience
Education
Specific Needs
Other
Religious Affiliation
What Religion?
Affiliation
Profit
Do you wish to be referred to parents?
If you answered No please explain why
Camp Notes
Sign up to receive our e-mail newsletter and news alerts from 4C Council