Youth Program Registration & Insurance Request Form

Youth Program Registration & Insurance Request Form

Please use the following form to register youth programs sponsored by UO or hosted on the UO campus. Departments should complete a registration form for each youth camp or program annually.

Insurance: UO sponsored youth programs are required to enroll in camp insurance. Coverage is generally limited to medical expenses for accidental injury and accidental death and dismemberment. To request coverage, complete this web form at least two weeks prior to the start date. You will provide an estimated number of participants; after the program, Risk Management will charge based on the final number of participants.

For non-UO sponsored programs - Departments renting facilities to groups or entities hosting youth centered programming such as camps/clinics must register the program with the Office of Risk Management and Insurance. This form may be used for that registration.

Prior to the start of any program or activity involving minors, Non-university organizations must confirm that they have conducted criminal background checks of their employees, volunteers, and representatives and that they have conduct and training requirements in place that meet or exceed the University’s standards.

REGISTRATION

Complete the following section to register your program regardless of whether you will purchase insurance.

Name of UO department coordinating the activity:*

Name of the program:*

The official title of the camp, clinic, or activity.

Description of activity*

Do not list multiple camps in this field. Departments must register each individual camp to be held.

Location of program/activity:*

(If on campus, provide the building name; if off campus, provide the building name and address)

Programming provided will be held virtually

Description of Virtual Program

Please list the platform(s) your program will be delivered through. Describe the level of interaction with the minors (IE webinar or virtual break out rooms?)

Day program or Overnight?*

Select or enter value

Overnight Location*

If this is an overnight program please indicate the campus residence hall or if sleeping quarters are off campus please provide the street address/location. Indicate N/A if not an overnight program.

Is the activity sponsored by the UO?*

UO sponsored programs are supported by a department or recognized student group (ASUO). Please select no if this registration is for a third party youth program.

Select or enter value

Name of Entity Renting Facility

Prior to the start of any program or activity involving minors, Non-university organizations must certify that they have conducted criminal background checks of their employees, volunteers, and representatives and that they have conduct and training requirements in place that meet or exceed the University’s standards.

Please check this box to indicate a facility use agreement has been completed.

The facility use agreement should require at minimum the following coverages:

$1Million Commercial General Liability with coverage for Sexual Abuse/Molestation coverage.

$1Million Auto Liability coverage if transporting passengers is a requirement of their contract.

$1Million Workers Compensation coverage for employees.

A certificate of insurance from the entity renting the University leased or owned facility has provided a copy of their insurance which meets or exceeds the above listed insurance requirements.

Names of staff/UO paid employees working overnight*

List all employees working over night, include title and very brief description of duties - If day program, skip to next question

Start Date:*

Finish Date:*

Estimated number of participants:*

Please follow-up with Risk Management when the activity is over and provide the total number of actual participant numbers. As insurance is billed based on the total number of minor children participants.

Number of Participants (non-UO sponsored)

Age range of participants*

Number of Staff/UO paid employees*

Staff and volunteers should not be included in the number of participants and are not covered by this insurance.

Number of volunteers*

Staff and volunteers should not be included in the number of participants and are not covered by this insurance. Please complete volunteer forms available on orm.uoregon.edu.

Outside Vendor Primary Contact Name

Outside Vendor Primary Contact Phone Number

Youth Program Coordinator*

(Primary contact & position title - Note this must be a UO faculty or staff member

Primary contact phone number*

Primary contact email*

Secondary contact person*

Secondary contact phone number*

Secondary contact email*

INSURANCE ENROLLMENT

Do you want to purchase insurance for this activity or program?*

Risk Management expects university departments and program sponsors to purchase this insurance. It is particularly important for events involving minors, physical activity, overnight stays, or travel.

Select or enter value

IF NO: Please indicate the reason insurance should be waived.*

This will be reviewed by Risk Management.

Index to bill:*

By providing this information you authorize this cost to be charged to the indicated index.

Activity Code*

Attach Protection of Minors Program Summary Form

Drag and drop files here or

UO Department contact information: Please provide full name and title

UO Department contact information: Phone number

Send me a copy of my responses

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