UMN Program Submission Form

To be completed by University of Minnesota staff. Registering a program means the program leader has read and understands the Safety of Minors Policy, including the Health and Safety Appendix.

Basic Information

A short 2-3 sentence description.
I verify that all program staff (faculty, staff, students- including student employees- or volunteers) who are required to complete the U of M training on safety of minors and pass a background check have or will have done so within three years prior to the event. I also verify that this program has established practices for program activities that adequately address health and safety considerations for minors.

Program Information

Months Offered
According to the start and end date, please select all the month(s) your program resides in.
Age
Select all that apply.
Subject
Select one or more.
Program Location
Select campus/region as well as if your program will be delivered in-person or virtually (check both boxes if your program plans to deliver both in-person and virtually).
Publish on Youth Central website?

Staffing Information

Have all covered staff/volunteers passed a background check within the last three years?
Have all covered staff/volunteers completed the Safety of Minors mandatory training via the Training Hub?
Will there be a minimum of two program staff on duty at all times who are 18 or older and two years older than the oldest participant?
Will all program staff/volunteers/student workers receive an orientation?
The orientation should include expectations for program staff behavior when interacting with youth (both in-person and virtually), supervising, chaperoning or otherwise overseeing minors in program activities, recreational activities, and/or residential facilities.

Safety of Minors Information

Have you planned appropriate physical environments to ensure quality learning environments and help prevent illnesses and accidents?
Is there a plan to change facilities or modify activities for participants with special needs?
Is there a plan to change facilities or modify activities in case of extreme weather?
Have you assessed the environment to determine if minors need to be accompanied to the bathrooms?
Environmental assessment may include considering the relative age of participants, the presence of minors or adults not from the same program, sight lines, and distance.
Is there a plan for the safe movement of minors?
Do minors attend without a parent or other caretaker?
Please review the health and safety requirements on this page: https://policy.umn.edu/operations/minorsafety-appa
Does the program collect and keep within easy access information on each participant including current medications administered during program time frame and contact information for parents/guardians?
Do program staff know how to find and use this information?
Has the program established and communicated practices to prevent accidents and illnesses, including adequate first aid and proper handling of medications?
Does the program have emergency plans for fire, weather (e.g., tornado), toxic gas evacuations, unfamiliar packages, intruders, lost or missing children, and other emergencies?
Has the program established and communicated to program staff appropriate procedures for addressing emergencies, accidents and illnesses?
Will the program obtain a signed release of liability from all parents/guardians of minors prior to participation?
Does the program lodge people overnight?
More information on health and safety requirements can be found here: https://policy.umn.edu/operations/minorsafety-appa
Will the program follow lodging requirements?
More information on lodging requirements can be found here: https://policy.umn.edu/operations/minorsafety-appa
Will there be a minimum of two program staff on duty overnight who are 21 or older?
Has the program operated previously?
Were any incidents of suspected abuse known to have been reported to or by staff in the last year?
Was the incident reported to police, sheriff or local social service agency?
Did the incident allegedly occur during the program or involve program staff or volunteers?
If yes, contact the policy owner to review actions, including preventing future incidents.

Virtual Program Information

Is this a virtual program?
Is the platform supported by the University of MN?
Supported platforms include Zoom, Flipgrid, Microsoft Teams, and Canvas.
Will you be live streaming your program?
Have all staff/volunteers completed virtual safety guidelines training?
Has oversight been established to include a minimum of two adults during all virtual engagement activities?
Is recording taking place?
Have all participants been informed that the recording will take place?
Has the purpose for the recording been communicated to all participants?
Will you delete the recording within 30 days?
Will the recording be kept on a University accessible device?
I verify that I have read and understand the Safety of Minors Policy, including the Health and Safety Appendix. I verify that all program staff (faculty, staff, students- including student employees- or volunteers) who are required to complete the U of M training on safety of minors and pass a background check have or will have done so within three years prior to the event. I also verify that this program has established practices for program activities that adequately address health and safety considerations for minors.