Third Party Sponsor Certification Form
I, individually and on behalf of ______________________________________ [Non-University 3
rd
Party sponsor]
certify that only those employees/volunteers who have successfully completed a background check within the
past one (1) year will be permitted to supervise or have substantial contact with the minors. Further, only those
adults who are over the age of 21 and have had both a background check and a department of motor vehicle
check will be permitted to transport any minors in relation to the Event.
Provided, further, I certify that all employees/volunteers have been instructed on proper line of sight
supervision of minors and that both employees/volunteers/minors and their parents have been instructed on
safety and security procedures and notified of applicable University policies and relevant contact numbers
should any injuries or abuse occur.
I certify that there will be a sufficient number of adult supervisors for the minors taking into consideration best
practices and the nature of the location and Event.
I certify that each minor attending the Event has executed the applicable permissions, waivers, and releases, as
have all the employees/volunteers.
I understand that should the University become aware of any violations of this certification or of the attached
Sponsor Acknowledgment, the University will immediately remove the Event from campus and not reimburse
any amounts already paid by parents, minors or sponsor for the Event.
Event/Program Name: _________________________________________________________________________
Non-University 3
rd
Party (Company): ______________________________________________________________
Address: ____________________________________________________________________________________
City:_________________________________________ State:___________ Zip:_______________________
Contact Phone: ________________________________ Cell Phone: ____________________________________
Signature: ________________________________________________
Print Name: _______________________________________________
Date: ____________________________________________________
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