Youth Program Registration - Risk Management

Program Name: *

Is this a University Program or Third-Party program? *

University Program Third-Party Program

Program Location *

On Campus Off Campus

Who is responsible for the supervision of minors during the program? *

University Third-Party Organization Parent/Legal Guardian Chaperone

Program Start Date *

Program End Date *

Program Frequency *

One-time Event Several time per year Ongoing

Program Director Name: *

Program Director Mobile Phone Number (24/7 availability during program operations): *

Type of Program: *

Mentoring, Tutoring Camp, Clinic, Workshop Community Service Other

Does your program involve high-risk activities (e.g., swimming, labs, hazardous materials, transportation)? *

Yes No

Program Description *

Program Participant Age Group *

Preschool Elementary School Middle School High School

Number of Participants in Each Session *

Is this an overnight program? *

Yes No

Have you completed the online United Educators training? *

Yes No, not yet

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