External Protection of Minors Event

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At least thirty (30) days prior to the event, complete and submit this form with attachments.

Please be prepared to answer the following questions.

Sponsoring Unit (If applicable):
Program Title:
Date Program Begins:
Transportation: Including the transportation of minors at the beginning and end of the activity, to and from the activity, and within the program, whether by parents, guardians, staff or others. Activities must comply with university policies regarding drivers and vehicles.

Plans for weather emergencies and other emergencies.
Plans for providing adequate supervision for minors.
Plans for educating event personnel about appropriate conduct standards with and around minors.
Plan for alerting participants about how to report issues, including issues with peers, event personnel and others.
Plan for collecting and maintaining appropriate permission forms, medical contact information and liability waivers.
Plans for addressing medical emergencies.
Attach a complete list of volunteers with their contact information, including email address.
Overnight Activities: If No, the documentation listed below is not required.

Activities including overnight stays by minors shall have the following additional protocols:
Describe the identification to be worn by staff members, and participants if appropriate.
State the applicable curfews.
Provide a copy of the code of conduct or other conduct standards for participants.

Please note: this checklist is a guideline and will require you to submit full answers to all bulletin points

PROGRAM INFORMATION

Your Name:*

Your Email:*

Your Phone:*

Program Title:*

Program Dates and Times:*

Program Location(s):*

Do you have a contract in place with the University of Illinois? (yes or no)*

Yes

UIS Hosting / Supervisory Unit:

Type a number in this field and hit Tab. Persons (at least 2) responsible for making arrangements for the safety of minors and other participants in the event of an emergency (name, email address and phone numbers):*

Type a number in this field and hit Tab. Persons (at least 2) responsible for making arrangements for the safety of minors and other participants in the event of an emergency (name, email address and phone numbers):
First & Last Name:	Email Address:	Phone Number:

First & Last Name:	Email Address:	Phone Number:
First & Last Name:	Email Address:	Phone Number:
First & Last Name:	Email Address:	Phone Number:
First & Last Name:	Email Address:	Phone Number:
First & Last Name:	Email Address:	Phone Number:
First & Last Name:	Email Address:	Phone Number:
First & Last Name:	Email Address:	Phone Number:
First & Last Name:	Email Address:	Phone Number:
First & Last Name:	Email Address:	Phone Number:
First & Last Name:	Email Address:	Phone Number:

Estimated Attendance (Include Participants and Volunteers):

Target Age Range:*

Detailed Program Description:*

Compliance Checklist

Please note: this checklist is a guideline and will require you to submit full answers to all questions.

Explain your plans for weather and other emegencies:*

Transportation (If no transportation, enter N/A)*

Including the transportation of minors at the beginning and end of the activity, to and from the activity, and within the program, whether by parents, guardians, staff or others. Activities must comply with university policies regarding drivers and vehicles.

Please provide details for providing adequate supervisor(s) for minors*

Please provide details for educating event personnel about appropriate conduct standards with and around minors.*

Detailed plans for alerting participants about how to report issues, including issues with peers, event personnel and others.*

Detailed plan for collecting and maintaining appropriate permission forms, medical contact information and liability waivers.*

Detailed plans for addressing medical emergencies*

Please upload a document with a list of all individuals working with minors (staff, students, and volunteers, including yourself). Please include legal name, phone number, and email address.*

You can also access a pdf form with a formatted list of individuals working with minors Here

Are there Overnight Activities?*

Yes

Describe the identification to be worn by staff members, and participants if appropriate.

State the applicable curfews.

Provide a copy of the code of conduct or other conduct standards for participants.

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