Programs Involving Minors

Name of WPI Representative Completing the Form *

Email Address *

Program Name *

Program Sponsor(s) *

Program Date(s) *

Program Location(s) *

Approximate Number of Minors Participating: *

Please describe your program including (e.g., age(s) of Minors, types of activities planned, use of campus spaces, overnight on campus, etc. *

Check one *

In-Person (On Campus)

In-Person (Off Campus)

Virtual

By submitting this Program Registration form, I am acknowledging and agreeing as follows:

I HAVE READ AND UNDERSTAND THE PARTICIPATION OF MINORS IN WPI PROGRAM'S POLICY ONLINE HERE, ACKNOWLEDGE THAT THE PROPOSED PROGRAM IS SUBJECT TO THAT POLICY, AND AGREE ON BEHALF OF THE PROGRAM TO COMPLY WITH THE POLICY. *

I HAVE READ AND UNDERSTAND THE PARTICIPATION OF MINORS IN WPI PROGRAMS POLICY

I UNDERSTAND THAT A PARENT OR LEGAL GUARDIAN OF EACH MINOR PARTICIPANT IN THE PROGRAM WILL BE REQUIRED TO SIGN A PARTICIPANT WAIVER AND PERMISSION FORM ON BEHALF OF THE PROGRAM SPONSOR(S) TO ENSURE THAT SUCH WAIVERS ARE COLLECTED AND PRESERVED. *

I UNDERSTAND

I WILL REQUEST A BACKGROUND CHECK FOR ALL PROGRAM DIRECTORS AND SUPERVISORS, AND ALL ADULTS WHO WILL HAVE DIRECT AND UNMONITORED CONTACT WITH MINORS DURING THE COURSE OF THE PROGRAM INCLUDING BUT NOT LIMITED TO FACULTY, STAFF, STUDENTS, CONSULTANTS, CONTRACTORS, VENDORS, AND VOLUNTEERS. I UNDERSTAND THAT AN ADULT CANNOT HAVE DIRECT AND UNMONITORED CONTACT WITH MINORS DURING THE COURSE OF THE PROGRAM UNLESS AND UNTIL A SATISFACTORY BACKGROUND CHECK HAS BEEN RECEIVED. *

I UNDERSTAND

I UNDERSTAND THAT ALL ADULTS WORKING WITH MINORS IN THE PROGRAM ARE REQUIRED TO RECEIVE TRAINING ON POLICIES AND ISSUES RELATING TO INTERACTIONS WITH MINORS. TRAINING MUST BE COMPLETED PRIOR TO AN ADULT BEGINNING WORK WITH MINORS. *

I UNDERSTAND

I UNDERSTAND THAT ALL ADULTS WORKING WITH MINORS IN THE PROGRAM ARE REQUIRED TO SIGN THE BEHAVIORAL EXPECTATIONS ACKNOWLEDGMENT FORM THAT REVIEWS THE BEHAVIORAL EXPECTATIONS OF THE PARTICIPATION OF MINORS IN WPI PROGRAMS POLICY. THE FORM MUST BE COMPLETED PRIOR TO AN ADULT BEGINNING WORK WITH MINORS. *

I UNDERSTAND

FOR THIRD PARTY SPONSORS ONLY: I UNDERSTAND THAT I MUST HAVE EXECUTED A WRITTEN CONTRACT WITH WPI.

I UNDERSTAND

Name *

Date * +

Currently, what country are you physically present in? *

*

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