Youth Program Registration (for LSU Supervised Programs)

Youth Program's Name*

The name of the youth program, activity, or event.

Program Description*

Please select your program's type from the list below.

Select or enter value

LSU Department*

Objective(s) of Youth Program*

Please list the goals the program intends to achieve.

Program Administrator and/or Program Coordinator Name*

Program Administrator and/or Program Coordinator Email*

Program's Contact Person*

Program's Contact Email*

Program's start date*

Program's end date*

# of occurrences, per fiscal year*

# of staff members

# of volunteers (est.)*

# of minor participants (est.)*

Program's Location(s)*

Age range of participants*

Select

Will the program require overnight stay?

If yes, please list the assigned Residential Hall.

Youth Program's Policies, Form and Documents*

Please upload additional information including: One blank copy of the forms used by the program (registration form, waivers, medical form, etc.) Third party contracts, etc.

Drag and drop files here or

Background Check and Training Acknowledgement*

By submitting this form, I acknowledge that all adults including program staff, authorized adults, volunteers, etc., working or volunteering for this program/activity being hosted or sponsored by this department during these dates have successfully completed the Basic Training For Adults Working and Youth Programs and a background check in compliance with PM-16 and LSU Human Resource Policy.

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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