Program for Minors Registration Form Instructions

Program for Minors Registration Form Instructions

Program for Minors Registration Form Instructions

Below are basic instructions and answers to common questions about our registration form.

If you have other questions, or need further assistance in any way, please contact Faith Garner at 423-425-5741 or .

I.GeneralProgram Information:

  1. Please describe theCoveredProgram below. (Include the programtitleand date of program.)
  1. We doneed both the titleof the program and the dates of the program.
  2. Separate registration forms are required for each program, even though they deal with the same basic subject. If in doubt, call us.
  3. You do not need to fill out a separate registration form if you are having the same camp on two separate occasions, as long as the programs are identical in implementation, location and staffing.
  4. We really do need a brief description of your camp. Basically, just tell us the main objective of your camp. Explain where your camp is being held. Provide additional information that would help us better understand your operation or goals.

Example Entry:

My Favorite Program Camp – Jan 1-5, 2015, and March 1-5, 2015, 1p-4p daily

Camp Location: Favorite Building, Favorite Room Number
My Favorite Program Camp is a fun, innovative camp designed to increase. . .for elementary school students by encouraging. . .and by utilizing. . . . While this is primarily an academic camp, we will be launching our favorite end result at Favorite Outdoor Venue on 5th Street.

  1. Please list the UTC employee(s) with primaryresponsibilities for the CoveredProgram.
  1. This is not a complete list of the UTC employees who will be participating in the program. (That’s the next item.) Generally, this is one or two people who are the program leads or main contacts for this program.
  1. Please list names ofallCoveredAdultsparticipating in the CoveredProgram.
  1. You may attach a separate sheet listing all covered adults. We have created a form that is ideal for this. (Camp Staff Worksheet—Form A1) This form can also help with tracking all of the forms needed for each covered adult.
  2. Please do remember that we need the same forms for the program leads listed in Item B. (Those people listed above.)
  3. If you only have a few people working the event, you may certainly list them in the space provided here.
  1. Please attacha copy ofa Driver’sLicense or government-issuedphotoidentificationfor eachCoveredAdult.

1.This item is listed separately because many people overlook this necessary step in documenting covered adults.

2.You do not, however, have to attach copies here, and then, send additional copies with your other covered adult forms. One copy is all that is required.

  1. CommunicationPlan:

Please provide below a description of the Communication Plan to be followed by the Covered Program. The Communication Plan must include:

  • A procedure for obtaining and maintaining contact information for participants’ parents or legal guardians, aswellas emergencycontacts in the event the parents/guardiansare unavailable;
  • A procedure for notification of allparticipants’ parents/legalguardians in the event ofanemergency; and
  • A procedure for parents and guardians to follow to contactCoveredProgrampersonneland/or their childduringCoveredProgramhours.
  • Include EmergencyAction Plan to be followed for weather relatedemergencies(i.e.tornadoes, lightning,extreme heat, etc.)
  1. How will you obtain this contact information? Where will you store this information so that it is easily accessible during the camp? How will you provide your contact information to the parents?
  2. Your department or your location site should have emergency procedures already in place. However, you are responsible for understanding these procedures, ensuring that all covered adults understand these procedures, and asking for guidance from our department if you have questions regarding these procedures.
  3. How will parents contact you if they have an emergency and need to pick up their child early? If you provide cell phone numbers to them, will you have those phones with you at all times? If you provide an office number, will someone be manning that phone throughout the course of the program? Will you check for messages regularly?
  4. You do not have to include emergency procedures for each type of emergency that is possible during your program, although you are welcome to do so. You may simply reference the procedure document that exists in your office, with any additional measures needed for your campers.

III.MedicalEmergencyPlan:

Please provide belowanoutlineofthe Medical EmergencyPlan to befollowedbythe CoveredProgram.The Medical EmergencyPlanshall complywithUTC’s policyimplementing UniversityofTennessee System SafetyPolicy575, andshall include:

  • A procedure for obtainingand maintaining(i)authorization fromallparticipants’ parents/legal guardians to transport aCoveredProgram participant to localhospitalsasdeemednecessary;and (ii) authorizationfor emergencymedicaltreatments in the event the parents/legalguardians ortheir designated emergencycontactare notavailable;
  • A procedure for obtainingand maintainingdisclosures ofanyallergies orother medicalconditionor physicallimitationthatmightimpactparticipation in the CoveredProgram;and
  • A procedure to administer medication to CoveredProgramparticipantsas necessaryduringCovered Programhours.
  • Ifthe CoveredProgramwill involve strenuousphysicalactivity,FormsB,B1,B2,and Dmust beused in the CoveredProgram.
  1. While programs that do not involve strenuous physical activity are not required to turn in the forms referenced above, many academic programs also utilize these forms. If you have any potential hazards, you may want to consider looking over these forms to see if they might benefit you. If you would prefer to develop your own forms for the purpose of gathering medical information, they must be approved by Safety & Risk Management to ensure that they are sufficient for the needs of the Programs for Minors policy.
  2. You may not exclude participants based solely on health issues. If you have concerns about a particular medical condition, contact our department for guidance.
  3. If your camp does not provide over-the-counter medication to participants, you may opt out of Form B2. Usually, these camps adopt the policy that, if the camper has a headache or stomach issue that keeps them from participating, the parent/guardian will be contacted and the camper will go home. Just remember that, even if your camp’s trainer is the person administering the drugs, your program does need to complete this permission form.

IV.SupervisionPlan:

AllCoveredProgram activities involvingminorsshall be supervisedbyat least two or more Covered Adults. There shall beno one-on-one contactbetween aminor and a CoveredAdultunlessone-on-onecontact is essential to the CoveredProgramandhas been approved in advance bytheChief Safetyand Risk Management Officer.The term “one-on-one contact” shall mean private,unsupervised,face-to-face interactionbetween a minor and a CoveredAdult withoutatleastanother CoveredAdult,parent,or legalguardian being present.

Please provide belowa description ofaSupervision Plan to be followed bythe CoveredProgram.Please include inyourdescription:

  • Whetheryouarerequestinganexception to the rule prohibitingone-on-onecontactbetween aminorand a CoveredAdult,and, ifso, anexplanation of whyone-on-onecontact is essential to the Covered Program.
  • The proposed ratio of participants to Covered Adults;
  • The breakdown ofCovered Adultsbycategoryof employees,studentsandvolunteers;and
  • Curfew,rules pertaining toanyvisitors,andlimitations, oruseof free timein the eventthe Covered Programinvolvesanyovernightstays.
  1. At no time, should one adult be left alone in the room with minors. Two adults should be present at all times. This goes to the very heart of this policy. No exceptions to this policy will be granted, unless one-on-one contact with an instructor is an integral part of the actual program. For example, music lessons are usually granted this exception.
  2. If you require an exception to that rule, please contact our office to discuss this. We want to work with you to make sure your program is a success, and we might have strategies that will help you achieve your goals!
  1. TransportationPlan:

Except in exigentcircumstances, orasspecificallyauthorized in writingbythe Chief Safetyand RiskManagementOfficer orthe minor’sparent or legalguardian, a Covered Adult shall not transport aminor who is not his/her ownchildwithoutanother CoveredAdult beingpresent, or transport aminor who is not his/her own child usinghis/her personalvehicle, duringtheCovered Program orto/from the CoveredProgram.

Please provide belowa description ofthe TransportationPlan to be followedbythe Covered Program. The TransportationPlan must include:

  • A procedure for the pick-up and drop-off of participants, specifying times and locations;
  • A procedure to obtain written permission from a parent or legal guardian in the event any participant is to be released to any person other than his or her parents or legal guardians; and
  • A description of any transportation of participants to be provided by the Covered Program, specifying the type of vehicle and the drivers. Note: Transportation of participants by Covered Adults must, in all instances, be reviewed and approved by the Chief Safety and Risk Management Officer.
  1. Pick-up and drop-off of young students must be fully explored and documented, in order to maintain supervisory contact at all times.
  2. Exceptions to any transportation being provided by only one Covered Adult may be granted on a case-by-case basis. Please contact our department to discuss your needs.
  1. Signatures:
  1. Two signatures are required in order to process this form.
  2. Forms received without two signatures will be returned to the program lead.
  3. There are no exceptions to this rule.
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