YOUTH PROGRAM INCIDENT/ACCIDENT REPORT



All youth program activities with participating minor children are required to be registered with Minors on Campus.


All Boise State personnel are mandated reporters and responsible for the welfare of all participants of both University and third-party programs.


All incidents/accidents should be reported whether resulting in medically treated injuries or not.


All mental health incidents/accidents are required to be reported, regardless of whether injury accompanies the incident/accident.


Verbalization of suicidal ideation, physical, sexual or mental abuse by another are required to be reported, whether the verbalization is intended as a report or unintentionally overheard.


Inappropriate physical, sexual or verbal actions by participants are required to be reported, regardless of ages or gender.


This form should be completed when an incident/accident occurs during a youth program held at Boise State University.

 

Program Information:

 

Please provide the name of the program as registered with Minors on Campus.

 
 

Please indicate if the program is being run by the University or a third-party entity.

 
 
Phone
 
 
 
mm/dd/yyyy
 
 
 
 
 

Incident/Accident Information:

 
 
 
 
mm/dd/yyyy
 
 
 
 

Participant Information:

 
 
 
 
 
 
 
Phone
 
 
 

Registration Document Information:

 
 

Program has on file a signed liability waiver by participant's parent/guardian.

 

Injury:

 

Treatment: