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Programs Involving Minors
Name of WPI Representative Completing the Form
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Email Address
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Program Name
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Program Sponsor(s)
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Program Date(s)
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Program Location(s)
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Approximate Number of Minors Participating:
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Please describe your program including (e.g., age(s) of Minors, types of activities planned, use of campus spaces, overnight on campus, etc.
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Check one
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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.
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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.
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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.
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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.
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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.
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I UNDERSTAND
FOR THIRD PARTY SPONSORS ONLY: I UNDERSTAND THAT I MUST HAVE EXECUTED A WRITTEN CONTRACT WITH WPI.
I UNDERSTAND
Name
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Date
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Currently, what country are you physically present in?
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Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas (the)
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory (the)
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands (the)
Central African Republic (the)
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands (the)
Colombia
Comoros (the)
Congo (the Democratic Republic of the)
Congo (the)
Cook Islands (the)
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican Republic (the)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (the) [Malvinas]
Faroe Islands (the)
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories (the)
Gabon
Gambia (the)
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (the)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (the Democratic People's Republic of)
Korea (the Republic of)
Kuwait
Kyrgyzstan
Lao People's Democratic Republic (the)
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia (the former Yugoslav Republic of)
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands (the)
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (the Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands (the)
New Caledonia
New Zealand
Nicaragua
Niger (the)
Nigeria
Niue
Norfolk Island
Northern Mariana Islands (the)
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines (the)
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation (the)
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan (the)
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan (R.O.C)
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands (the)
Tuvalu
Uganda
Ukraine
United Arab Emirates (the)
United Kingdom of Great Britain and Northern Ireland (the)
United States Minor Outlying Islands (the)
United States of America (the)
Uruguay
Uzbekistan
Vanuatu
Venezuela (Bolivarian Republic of)
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
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