Registration Form - Programs for Minors

Instructions:

This form should be used to register any new or existing Program for Minors as defined in the University’s Policy on Programs for Minors. The form should be completed and signed by the designated Program Sponsor, and it must also be signed by the Program Administrator who approved the Program. The form may be emailed to Risk Management/Central Registry for Programs for Minors, to the attention of Kristin McCann (kmccann4@ur.rochester.edu), who may also be contacted for questions.

Program Information

Name of Program:

School or Division responsible for the Program:

Name of Program Sponsor1:

Program Sponsor's Title:

Program Sponsor Phone Number:

Program Sponsor Email:

Date(s) and Times Program will be operational:

Number of Minors Expected to Participate (approximate):

Age Range of Minors Eligible to Participate in this Program:

Brief Description of Program:

In my capacity as the responsible Program Sponsor I hereby confirm that:

All minors who will be participating in the Program will be registered and written permission from a parent or guardian allowing the minor to participate will be on file prior to the minor being allowed to participate;
All information required by the University Policy on Programs for Minors and any additional information required by this specific Program will be obtained and will be on file before each minor is allowed to participate;
The parent or legal guardian of each participating minor will be provided with information explaining how to contact the participant, the Program Sponsor and Security during the Program;
There is or will be prior to the start of the Program a procedure approved by the Program Administrator for notifying parents and legal guardians of participants in the event of emergency, and the parent or guardian will receive a description of that procedure, in writing;
All supervision and contact with minors as part of this program will be limited to employees of the University2, who will have undergone background checks and will have been properly trained, as described in the University Policy on Program for Minors, prior to having any contact with minors as part of this Program.

For the Program Sponsor:
I hereby confirm that that I have reviewed and I am familiar with the University’s Policy on Programs for Minors and that the Program being registered meets or exceeds the requirements as stated in the Policy. I also confirm that I have reviewed the plans for the Program with the responsible Program Administrator who approves and supports the plan.

Please agree:

For the Program Administrator:
I hereby confirm that I have reviewed the plans for this Program for Minors, found it to be in compliance with the University’s Policy on Programs for Minors, and I have approved the creation or continuation of the Program.

Please agree:

Name of Program Administrator3:

Program Administrator's Title:

1 The Program Sponsor is the employee of the School or Division who has been assigned responsibility for oversight of the Program by the Program Administrator (who will usually be the Dean of the responsible school, or another high level administrator within the School or Division sponsoring the program). The Program Sponsor should also be the person completing this Registration Form.

2 If the Program will involve any outside vendor or individual who is not an employee of the University different registration requirements will apply; contact Risk Management for details.

3 a University administrator authorized by the School or Division to evaluate the program and provide such approval.