Minor’s Program Registration Form

Program/Activity Title(Required)

Program/Activity Leader's Name(Required)

Leader's Email(Required)

Leader's Phone(Required)

Program Type(Required)

Program Activity Type(Required)

All use of recreation facilities/fields must be reserved through campus recreation.

Description of Program(Required)

Date(s) of Program/Activity(Required)

Length of Program(Required)

(e.g. 9am-2pm, full day camp or overnight)

Location of Program/Activity(Required)

Building name(s), field or off-campus location(s)

Program Accomodations(Required)

Campus Housing

Campus Dining

Transportation of Minors

None of the above

Please check all that apply.

Maximum # of Minor Participants(Required)

Age Range of Minor Participants(Required)

Academic discipline related to learning experience (if applicable)

Is the program part of a grant or department sponsored program?(Required)

Program Website

You will be required to supply the following information after you submit this form to Risk Control and Insurance. 1. Personnel List, 2. Program Itinerary, 3. Marketing Material about the Camp/Event. 4. Third Party Program information including Facility Use Agreement and Certificate of Insurance.