Registration Form for Program with Minors

REGISTRATION FORM for PROGRAM WITH MINORS
It is the policy of Belmont University that any program, activity, service or event involving minors, on or off campus, sponsored by any academic administrative or athletic department of Belmont University; or programs, activities, services or events involving minors, on or off campus, sponsored by non-Belmont, external entities, using University facilities, must be registered with Office of Risk Management and Compliance prior to the

commencement of such program, activity, service or event.

This form will be submited to: riskmanagement@belmont.edu and hr@belmont.edu. Please contact them if you have questions.
Date Submitted:*

MonthDayYear
Date
Name:*

TitleFirst NameLast Name
Department/Organization:*
Email:*

Confirmation EmailRetype Email
Address*

Street Address

Street Address Line 2

CityState

Zip Code
On Campus Contact with Program*

First NameLast Name
On Campus Contact Phone Number*
Please enter a valid phone number.

PART 2: PROGRAM INFORMATION
Name of Program/Activity/Event:*
Brief Description of Program/Activity/Event:*
External Entity/Individual partnering with Belmont:
Buildings/Rooms on Campus*
(Please specify building.room)
Begin Day/Date/Time of Program/Activity/Event:*

MonthDayYear
Date
Hour MinutesAM/PM Option
End Day/Date/Time of Program/Activity/Event:*

MonthDayYear
Date
Hour MinutesAM/PM Option

Number of Minors (Please specify if Estimation):*

	Number of Minors
Early Childhood Students (Pre K-2)
Elementary Students (3-6)
Middle School Students (7-8)
High School Students (9-12)

For additional space, please format and upload an excel spreadsheet (optional):

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	Fund	Org	Account	Program	Activity
FOAPAL

Please inform all faculty, professional staff, students, volunteers or contractors participating in the Program/Activity/Service/Event of the following:

Required background screening:

*With the requested information (email and cell #), HireRight will send an email as well as a text message to the potential employee/chaperone/volunteer to complete the needed information to begin the background check. Once information is received from HireRight via text/email, please complete immediately.

*If you do not see an email from HireRight in your regular inbox, please check your spam inbox.
Required Training Information
*Before being allowed to work any program/event as a camp worker/chaperone and/or volunteer, you are also required to complete training on Belmont’s Protection of Minors on Campus policy. Please click on the link below to access the online training.

https://www.belmont.edu/risk-management/protecting-minors.html
Who’s Responsible?
It is the responsibility of the person in charge of the Program (Program Director) to ensure that each participating adult has completed the required background check and has completed the Protection of Minors Training.
Attach any additional timeline/schedules or additional information for the program

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PART 4: FORM ASSISTANCE FOR REGISTRATION
Do you need assistance in creating or editing an existing form for participant registration?*

YesNo
Should be Empty:

REGISTRATION FORM for PROGRAM WITH MINORS