Risk Management: Programs and Activities Involving Minors

Programs and Activities Involving Minors
Please complete and submit this form to register any program or activity that will include minors as participants.This may include athletic camps, academic camps, licensed childcare facilities, instructional programs, internships with individual staff or faculty, and other organized programs and activities intended for minors.
Program Information
Name of program *
Is this a third party program? *

Yes No
Describe any activities likely to be performed by participants: *
This information is for parents and guardians of the participants.
Program start date *

Month Day Year
Date
Program end date *

Month Day Year
Date
Name of sponsor school, college, or department *
Program location/venue *
If multiple venues will be utilized, please provide an overview of the itinerary including venues with this submission, or email the itinerary to us at safetyaid@suu.edu
Number of minors anticipated to attend program *
Will minors be working in a science lab? *

Yes No
Age ranges of participants *

< 6 years 6 - 8 years 9 - 13 years 14 - 17 years
Program Director/Primary Contact Information
Program director/primary contact name *

First Name Last Name
Phone Number *

Area Code Phone Number
Email *
example@example.com
SUU Department
SUU Department Billing Index
Departments are responsible for the cost of background checks and related fees. The department’s billing index will be used to make interdepartmental transfers to cover these costs
Submitter's Contact Information
Submitter's contact name *

First Name Last Name
Phone Number *

Area Code Phone Number
Email *
example@example.com
I certify full understanding of Southern Utah University’s Minors on Campus and at University-Sponsored Events policy and agree to comply with the requirements of that policy to ensure all minors participating in University sponsored programs will remain safe during their participation. Further, as the Program Director, I understand that compliance with the policy must be satisfied and recorded by the SUU Risk Management Office before the program may take place, despite any services and/or facilities bookings that may have been secured and/or any financial obligations that may have been incurred.
Signature *

Clear
Should be Empty:

Programs and Activities Involving Minors

Program Information

Program Director/Primary Contact Information

Submitter's Contact Information