Youth Program Registration Form

Youth Program Registration Form

Important:

All requirements must be met and all documentation must be submitted and receive final approval before the program / activity begins.

Section A. Contact Information

Program Entity*

CSUN Department

Third Party or Co-Sponsored Programs

Are you co-sponsoring or partnering with a third-party entity?

Select or enter value

HR Entity*

CSUN

USU

Third Party

Program Sponsor College/Area (for CSUN Departments)*

Select

Program Sponsor College/Area (for 3rd Party or Co-Sponsored Programs)*

Select

Program/Activity Director Name*

Program/Activity Director Phone*

Phone

Program/Activity Director Email*

Section B. Program Information

Program/Activity Name*

Description*

Location*

Start Date*

End Date*

Will there be more than one Program/Activity Session during the same year?*

Yes

If yes, what is the frequency?*

Section C. Participants Information

Age of Participants*

Select all that apply

Up to 5 years

6 to 8 years

9 to 14 years

15 to 17 years

Supervision Ratios:

The following supervision ratios are used by the American Camp Association for non-overnight activities. At a minimum, CSUN has elected to require these same ratios for non-overnight programs run or affiliated with CSUN or conducted on CSUN property.

Age Range Adult to Minor Ratio Day Camps

Up to 5 years ........................................... 1:6

6 to 8 years .............................................. 1:8

9 to 14 years ............................................ 1:10

15 to 17 years .......................................... 1:12

Anticipated Number of Participants Up to 5 yrs*

Anticipated Number of Adult Supervision Up to 5 yrs*

Anticipated Number of Participants 6 - 8 yrs*

Anticipated Number of Adult Supervision 6 - 8 yrs*

Anticipated Number of Participants 9 - 14 yrs*

Anticipated Number of Adult Supervision 9 - 14 yrs*

Anticipated Number of Participants 15 - 17 yrs*

Anticipated Number of Adult Supervision 15- 17 yrs*

Section D. Employees/Volunteer/Independent Contractor Information

Anticipated Number of Program Employees*

Anticipated Number of Program Volunteers*

Anticipated Number of Independent Contractors*

Section E. Contact Level

Are there direct and/or one-on-one interactions between adults (staff, volunteers, independent contractors) and minors?*

Select

Will adults (staff, volunteers, independent contractors) transport or accompany children to different locations?*

Select

Are there any situations where adults (staff, volunteers, independent contractors) could be alone with a minor in non-public areas?*

Select

Does the program provide childcare, tutoring, or mentorship to minors?*

Select

Are parents/guardians required to be present with their respective child(ren)at all times during program activities?*

Select

Section F. Program Activities

Will the Program/Activity include a campus (or other CSUN facility) overnight stay?*

Select

Describe all activities that will occur in the program:*

Are there any particular areas of risk to minors involved in this program?*

Select

If YES, describe:*

Additional Information

File Upload

Drag and drop files here or

Section G. Program Exemption Determination

Is this program exclusively for college students, faculty, or staff with no direct engagement of minors?*

Select

Does the program only allow incidental contact with minors (e.g., public events, general campus activities)?*

Select

Section H. Livescan Exemption Determination

Live Scan Clearance?*

Will individuals working in this program be continuously supervised by personnel who have received Live Scan clearance and at no time will be left alone with a minor?

Yes

Certification of Program Director: *

I certify that the information provided is accurate and complete. I understand that misclassifying a program may lead to non-compliance with institutional and legal youth protection requirements, resulting in the program’s non-approval or cancellation.

Submit:

Click SUBMIT for preliminary approvals. You will be notified if your application has been approved, denied, or needs more information or documentation.

Important:

All requirements must be met and all documentation must be submitted and receive final approval before the program / activity begins.

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