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THIRD PARTY ACKNOWLEDGEMENT OF RESPONSIBILITIES

For use with programs/events sponsored by non-University, third parties. This form is to be completed by the Program Director in

charge of managing the event or program, and submitted to the Chief Risk & Compliance Officer with other required Program

documents.

Program/Event Information

Program Name: ______________________________________________________________________________________________

Program Director: _____________________________________________________________________________________________

Program Dates: _______________________________________________________________________________________________

Program Director Cell Phone: ___________________________________ Email: ___________________________________________

Wilkes University Facility Name: __________________________________________________________________________________

DUTY

By hosting a program/activity at Wilkes University, you are

accepting a legal duty to operate the program/event in a safe

manner consistent with the policies of Wilkes and all

applicable laws. You agree to indemnify, defend and hold the

university harmless for any and all claims, causes of action,

demands and damages arising out of or relating in any way to

the program/activity.

REQUIRED FORMS

 Facilities Use Agreement: The Facilities Use

Agreements are obtained from the location where

the event is to be held.

 Abuse & Molestation Insurance: A separate Abuse

and Molestation insurance in the amount of

$1,000,000 each occurrence and $2,000,000 general

aggregate, unless this coverage is specifically included

in the comprehensive commercial general liability

insurance policy. Evidence of specific inclusion shall

be required. If coverage for abuse and molestation is

not specifically included in the commercial general

liability coverage, a separate policy or rider shall be

required as evidence of said insurance. Policy/ies shall

be on an occurrence basis only.

 Parental Authorization and Waiver that informs

participants and their parents/legal guardians that

the third party organization’s event or program is

neither endorsed nor sponsored by Wilkes University.

CRIMINAL BACKGROUND CHECKS

All adult employees AND volunteers working at the

program/activity must have successfully completed a criminal

background check, including the National Sex Offender

Registry, within the past two years. You certify that only

employees/volunteers who have successfully passed a

background check within the past two years will be associated

in any way with the program/event. This requirement includes

parents of participants where the parent is assisting with the

program/event. Unless the parent has undergone the

background check and executed all the forms associated with

the program/event, they may not assist with the

program/event.

SUPERVISION

Supervision is defined as having the children/teens minor

within your line of sight. Ensure that there is an appropriate

chaperones/supervisors ratio. The university generally

requires a minimum adult supervisor/chaperone ratio as

outlined below.

However, depending on the age of the participants and the

nature of the activity, higher or lower ratios may be advisable.

Designate at least one person as a head chaperone and

provide their contact information to the University

representative. The head chaperone must ensure all

participants are properly supervised. Where participants are

staying overnight, chaperones must have a schedule of who is

on call and provide contact numbers to the Housing

representative.

Every participant must be chaperoned at all times by an

authorized adult while participating in the program/activity.

SAFETY AND SECURITY

To ensure the safety and protection of children and teens,

establish security measures (e.g., where to meet and where to

go if lost), and instruct them to communicate the security

measures to the children or teens on a daily basis.

REPORTING OBLIGATIONS

General

It is important to act immediately when criminal activity is

taking place, or in a circumstance where you find yourself

either a victim or a witness to questionable activity.

If you require immediate emergency assistance or believe a

crime is in progress, dial 9-1-1 to connect you to the police.

For a non-emergency situation, call the Department of Public

Safety at (570) 408-4999. Public Safety professionals can help

assess the situation and determine what other notification or

action is necessary.

Information on potential criminal activity also may be reported

to the university anonymously by calling the university’s

anonymous tip line at (570) 408-2273.

If you believe you have seen wrongdoing in the course of your

daily activities on campus, you can report the situation

anonymously through the University’s compliance website at

https://secure.ethicspoint.com/domain/en/report_custom.as

p?clientid=17812 or call the Compliance Hotline at (888) 332-

6790. The Hotline is available 24 hours a day and is staffed by

multilingual interview specialists.

Known or Suspected Abuse or Neglect of Minors

You do not have to know for certain that abuse is taking place.

Reasonable cause to believe or suspect that child abuse has

occurred is sufficient. Anyone who knows, suspects, or

receives information indicating that a child/teen has been

abused or neglected, or who has other concerns about the

safety of child/teen MUST inform the Department of Public

Safety.

Anyone who knows or suspects abuse or neglect of a

child/teen should also notify the Commonwealth of

Pennsylvania’s Department of Public Welfare by calling the PA

ChildLine at (800) 932-0313.

Mandated Reporters and Their Legal Obligations

(As defined in 23 Pa. Cons. Stat. § 6303) Persons who, in the

course of their employment, occupation, or practice of their

profession, come into contact with children, including all

Program Staff. Additionally, any person may make such a

report if that person has reasonable cause to suspect that a

child is an abused child.

All Wilkes University employees, students, independent

contractors and volunteers (collectively “Required Reporters”)

have a personal responsibility to report any instances of known

or suspected abuse, molestation or neglect relating to

children. If a minor is in imminent danger, the discoverer

must:

1. Make all reasonable efforts to remove the minor from

dangerous or potentially dangerous situations,

irrespective of any other limitation or requirement

2. Contact the police at 911 to obtain immediate

protection for the child.

3. Contact the Commonwealth of Pennsylvania’s

ChildLine at (800-932-0313)

CODE OF CONDUCT

Make sure your employees/volunteers understand, and you

have reviewed, the state requirements on reporting suspected

child abuse. Ensure that all authorized program adults have

reviewed what constitutes inappropriate contact with

participants and that it is not acceptable.

Ensure that all Authorized Program Adults have reviewed the

Code of Conduct outlined in the Minors on Campus Policy.

SAFETY AND SECURITY

 Ensure that you have reviewed security measures

with your staff and that they know who to talk to if

they need help.

 Ensure the participants and their parents know where

and how to report any injuries or incidents.

 Ensure that participants are checked in and out by

approved parents or guardians and that proper

identification is obtained and reviewed each time.

 Ensure that you have reviewed emergency

evacuation measures with authorized program adults

and participants.

 Ensure that participants and their parents know

where children will be picked up if they have missed

the standard pick-up and drop-off times. Ensure you

have a secure pick-up and drop-off protocol,

permitting only parents or legal guardians to pick up

minors. You should require photo identification of

these individuals.

 If someone other than the parent is to pick up the

minor, you must obtain written authorization from

the parent/legal guardian and require valid

identification from the person authorized to pick up

the child/teen.

 Ensure minors are aware of behavioral expectations.

 The information given to children/teens will depend

on their ages. At a minimum, they must be told where

to get help if they need it.

These guidelines supplement all university guidelines, policies

and procedures. If you have any questions about this

document, please call your university contact or Risk &

Compliance Management at (570) 408-4554.

I have read and agree to abide by these guidelines and attest

to my understanding of the guidelines and certify my

compliance with them.

Signature: _________________________________________

Program Director

Print Name: ________________________________________

Date: _____________________________________________

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