Legal Guardian Consent Form "MAAPP"

Parent/Legal Guardian's First and Last Name *

Parent/Legal Guardian Email Address (copy of form will be emailed to you for your records) *

Minor Athlete's First and Last Name *

Minor Athlete's USAV Member ID Number *

Regional Affiliation
Click To Find Region *

Full Club Name *

Club Email Address (copy of form will be emailed to your club for their records) *

Name of Authorized Coach / Adult(s) you are giving specific consent to *

Purpose of the Consent Form *

Dual Relationship

Meetings and Training Sessions

Athletic Training Modalities, Massages, and Rubdowns

Transportation

Lodging

Personal Care Assistant (PCA)

Please provide details to the above selected purpose of consent * 🛈

Dates this form is applicable * +

Legal Guardian Signature and Date *

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Description of Activities Requiring Legal Guardian Consent

ONE-ON-ONE INTERACTION POLICY

Policy Jurisdiction: All In-Program Contact.
All one-on-one interactions between an Adult Participant and Minor Athlete MUST be:
- Observable
- Interruptible
Exceptions to the One-on-One Interactions Policy:
- Emergency Circumstances
- Dual Relationships
- Close-In-Age
- Personal Care Assistant who meets the requirements

DUAL RELATIONSHIPS

When an Adult Participant has a relationship with a Minor Athlete that is outside of the sport program. A parent/guardian must provide written consent to the Organization on an annual basis for this exception to be granted.

MEETINGS AND TRAINING SESSIONS

Must follow One-on-One Interactions Policy when Minor Athletes are present.
Individual Training Sessions.
- Policy Jurisdiction: All In-Program Contact.
- Consent required from parent/guardian annually. Can be withdrawn at any time.
- Parents/Guardians must be allowed to observe.
One-on-One Interactions Policy Exceptions are allowed for In-Program meetings and individual training sessions.
Meetings with licensed mental health care professionals and health care providers.
- Policy Jurisdiction: At facilities that are partially or fully under the jurisdiction of the Organization.
- Meetings do not need to be observable and interruptible if the following requirements are met
  1. Door is unlocked.
  2. Another adult is present in the facility and is aware of the meeting.
  3. Organization is aware of the meeting.
  4. The provider obtains appropriate consent as required by law and ethical standards.

ATHLETIC TRAINING MODALITIES MASSAGES, AND RUBDOWNS

Must follow One-on-One Interactions Policy.
Must ALWAYS have a second Adult Participant in the room during treatment.
Required consent from parent/guardian that needs to be documented at least annually.
During treatment Minor Athlete’s breast, buttocks, groin, and genitals MUST always be covered.
Parents/Guardians must be allowed to attend treatment unless in a restricted area.
No policy exceptions.

TRANSPORTATION

Must follow One-on-One Interactions Policy, unless an exception exists or appropriate consent is obtained.
In-Program transportation requirements are met if the Adult Participant is accompanied by another Adult Participant or at least two minors.
One-on-One In-Program travel is permitted between an Adult Participant and a Minor Athlete when advance written consent is obtained from a parent/guardian on an annual basis. Can be withdrawn at any time.
Written consent must be obtained from a parent/guardian annually for all transportation sanctioned by the Organization.
One-on-One Exceptions are allowed.

LODGING

Must follow One-on-One Interactions Policy.
An Adult Participant CANNOT share a hotel room or otherwise sleep in the same room with a Minor Athlete during In-Program lodging except:
- When there is a Dual Relationship and written consent is provided by a parent/guardian prior to the lodging arrangement.
- When there is a Close-In-Age Exception and written consent is provided by a parent/guardian prior to the lodging arrangement.
- When there is a Personal Care Assistant Exception, all PCA requirements have been met, and written consent in provided by a parent/guardian prior to the lodging arrangement.
Written consent is required for all In-Program lodging at least annually.
Adult Participants traveling with an Organization overnight:
- Must agree to and sign the Organization’s lodging policy annually.
- Are assumed to have “Authority” and must comply with the Center’s Education & Training Policy.

PERSONAL CARE ASSISTANT (PCA)

When an Adult Participant is a Personal Care Assistant and has met the following requirements:

The Minor Athlete’s parent/guardian must provide written consent to the Organization for the PCA to provide care/work with their Minor Athlete.
The PCA must complete the required training as defined in the Education & Training Policy.
The PCA must meet all screening requirements of the Organization.