Online Complaint Form

All fields are optional, unless labeled as (required).

Information About You

Your Name Your Street Address Your City Your State Your Zip Code Your Email address Your County Your Telephone Number (home) Your Telephone Number (work) Your Role/Relationship to the children's camp (E.g., Parent of Child in Care, Employee, Centralized Intake, etc.)

Complaint Against

Children's Camp (required) License # Camp's Street Address (required) Camp's City (required) Camp's State (required) Camp's Zip Code (required) Camp's Telephone Number (required) Incident Date Is this a complaint regarding a children’s program operating without a license? (required) No Yes If yes, how do you know the children’s program is operating without a license? Who was involved? (If you know the names of the camp staff/employees/campers provide them) Please provide detailed information regarding what, when, and how often it happened, where it took place (specific area of the camp, offsite, etc), did other people see it (names if available), how you know this happened, and is it still going on. If you know the act section or rule violated, provide it.

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Online Complaint Form