Fillable Event Registrationform Part1upp42602 2017 (Marquette University)

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Event Registrationform Part1upp42602 2017 (Marquette University)

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OFFICE OF RISK MANAGEMENT
Reporting Form for Events involving Minors - UPP 4-26 Part 1
Name of Event/Workshop/Camp/Clinic/Activity:
Please provide supporting documents, copy of mailers or flyers, weblinks, and any internal proposals
or other documentation necessary for Risk Management to understand the full nature of the activities
involving minors. Incomplete submissions will be returned for supplementation before any further
action to approve activities or individuals will be taken by Risk Management.
Department/Unit:
Contact Person for additional information:
Name:
Contact No: Email:
Dates of Event: From: To:
Will this event From:
Be reoccurring? From:
this fiscal year? From:
To:
To:
To:
Will this event YES NO
Be reoccurring
Next Fiscal Year? If yes, estimated month scheduled:
Estimated Number of Minor Participants or maximum group number per session
Does any portion of this activity or program involve
the physical presence of individuals under the age of 18 who are
not registered University students (minors)?
YES NO
Does the portion of this activity or program that involves
minors take place on University property?
Does the portion of this activity or program that involves
minors utilize University equipment or other University
resources?
Reporting Form for Events involving Minors - Page 2
Is any college, department, or office of the University
listed as a sponsor of this activity or program?
YES NO
Does any college, department, or office of the University
have the authority to direct how the activities involving minors
will be undertaken?
Does the portion of this activity or program that involves
minors constitute a clinical treatment program
subject to the Wisconsin Caregiver Law?
Is the portion of this activity or program that involves
minors covered by a human research protocol approved
by the University Institutional Review Board?
Does the portion of this activity or program that involves
minors require that parents be present during that entire
portion of the activity or program?
Does the portion of this activity or program that involves
minors include any activity in which less than two adults may
be present with minors at any time?
Do volunteers who are not University faculty, administrators,
staff, or students participate in the portion of this activity
or program that involves minors?
Do registered University students who participate in the portion
of this activity or program involving minors receive credit
for their participation?
Will minors be transported to or from the event, or from place
to place on campus, by University faculty, administrators, staff,
or students?
Are minors involved in any overnight activity as part of this
activity or program?
Please provide any additional information that would be relevant to determining whether the requirements of
UPP 4-26, Working With Minors apply.
Name of Person submitting this form and contact number:
Date submitted:
ZILBER HALL TELEPHONE: (414) 288-6806
/
(414) 288-2803 FAX: (414) 288-0600
EMAIL: riskmanagement@marquette.edu
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Event Registrationform Part1upp42602 2017 (Marquette University)

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Completed 18 July 2020

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