Safety of Minors - Program Registration
Page 1
Is this youth program either offered or sponsored by an academic or administrative unit of the University or a recognized student group (whether held on or off University premises)?
Yes
No
Is this youth program offered or sponsored by a third-party operating on University premises or operating as a partner with a University department?
Yes
No
If you answered No to both questions please contact YPPS if you have questions about registering your program.
Program Name
Program Description
Type in a brief description or purpose of the Program.
x
Program Website (URL link)
Location
On Campus
Off Campus
On and Off Campus
Page 2
Program Begin Date
Begin Time
Program End Date
End Time
Program Type
Academic
Admissions/Recruitment/Pre-Enrollment
Athletics
Camp
Organizational (ex. Boys/Girls Scouts, 4H, Religious)
Recreational/Sport Camp
Service/Volunteer Outreach
Club (ex. Debate Club, Band, Other)
Conference
Other
Other
Targeted Age Groups
Pre-K
K-3rd
4th-6th
7th-8th
9th-10th
11th-12th
Total Number of Participants
Generally, refers to the minors who participate in a Program. Type in the estimated number of minors that will attend the session.
x
Total Number of Authorized Adults
Adults who will be engaging with minors as part of this Program. Type in the estimated number of Authorized Adult that will be engaging with minors as part of this Program.
x
Calculated Authorized Adult/Participant Ratio
1:
Department or College
Have you received approval from VP/Dean/University Official?
Yes
No
Name of approver:
Please provide your contact at the University:
Name
Email
Page 3
Primary Program Contact
The Program Primary Contact is the person that is ultimately responsible for the Program.
uNID
Name
Email
Phone
Do you have additional Program Administrators to add?
Yes
No
(One additional Program Administrator can be added)
Additional Program Administrator
uNID
Name
Email
Phone
Page 4
How would you like to add your Authorized Adult information?
Enter individually
Upload spreadsheet
Please use the template below to enter your Authorized Adult information. Once you have completed your Authorized Adult information, please be sure to save it as a .xlsx or .csv file before attempting to upload it here.
Authorized Adult Template
Authorized Adults
Authorized Adult
First Name
Middle Name
Last Name
Staff Type
University Student
University Staff/Faculty
Non-Affiliated Worker/Volunteer
uNID
Phone
Email
Background Check Date
Safety of Minors Conduct Training Date
Page 5
Please provide your Risk Management Plan*. You may copy and paste your plan here or upload a document below.
*For things to consider when creating a Risk Management Plan, please see our
Risk Management Guidelines
for more information.
Risk Management Plan
Certifications & Initials
I understand that background checks must be conducted every 3 years for all Authorized Adults prior to commencing work with children under the age of 18. Programs must ensure that background checks are conducted in accordance with the University of Utah Safety of Minors Policy.
Please see the
University of Utah Safety of Minors Policy
for more information.
I understand that all Authorized Adults are required to complete the Safety of Minors Code of Conduct training prior to commencing work with children under the age of 18.
I understand and agree that all authorized adults will have completed and passed a background check within the past 3 years prior to participating in the Program.
I understand and agree that all authorized adults will complete OEO Minors Safety training prior to participating in the Program.
I understand and agree that all minors must have completed the Liability Waiver form signed by a parent or legal guardian prior to participation in the Program.
For Non-University of Utah entities using the University campus for programs for minors:
The third-party entity has a contract with the University agreeing to be bound by the Minors Safety Policy that includes appropriate indemnification and insurance provisions.
The third-party entity provides required insurance or written proof of Risk Management waiver of insurance.
Contact Information
Information collected in accordance with our Privacy Policy.