Youth Program Registration (for Non-LSU Supervised programs)

Youth Program Registration (for Non-LSU Supervised programs)

Youth Program Name*

The term youth program refers to all program, events, and activities deemed a youth program by PM-16.

Objective(s) of Youth Program*

Youth Program Representative Name*

Youth Program Representative's Email*

Program's start date*

Program's end date*

Program's Location(s)*

Have you executed a Campus-Use License Agreement*

Select

Certificate of Insurance*

Select

File Upload*

Please upload the certificate of insurance.

Drag and drop files here or

Background Check/Training Certification

Please check this box if you've completed the mandatory background check/training certification form.

PM-16 Waiver Request

While Youth Programs should make the best effort to comply with PM-16, waivers to the policy can be requested provided it is deemed that a section of this policy would place an undue hardship on an activity or program with minors.

Would you like to request a policy waiver?

Select or enter value

If you selected yes please identify the sections

Select or enter value

If you selected other, please specify here

Please explain rationale for waiver request

If your request is approved, what actions will be taken in lieu of the waived requirement?

Data Authorization*

I authorize that all information provided on this form, including any and all personal, financial and academic data may be shared with the LSU Risk Management and university insurance carriers and vendors. This data will be securely retained indefinitely. To learn more about privacy at LSU, please see the LSU Privacy Statement.

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