Program Registration for Groups Working with Youth/ Children (under 18) in Any Capacity

Indicates required field

Johns Hopkins University instituted a Policy on the Safety of Children in University Programs in June 2012 (See http://webapps.jhu.edu/jhuniverse/administration/minutes_policies_reports/policies/child_safety/). As a result, all University groups working with youth/ children (under 18 years old) in any capacity (e.g. tutoring, workshops and symposia) for any length of time must register their program and complete a series of requirements. All programs must register whenever there is a change in primary contacts. If you have any questions or concerns about this registration, contact SOURCE at source@jhsph.edu or by calling (410) 955-3880.

Program Name (write out the entire name of the group, no acronyms)

Affiliation with Johns Hopkins University

School Affiliation

Program Description

Primary Contact(s) Information

Primary Contact (Full Name)

Primary Contact Phone Number

Primary Contact Email

Primary Contact Affiliation with Hopkins

Secondary Contact (Full Name)

Secondary Contact Cell Phone Number

Secondary Contact Email

Secondary Contact Affiliation

Information about Programs and Events

While it is challenging to create a form to capture the exact nature of your event(s), we want a sense of the type of event you are organizing for youth/ children. Special events such as overnight stays and field trips must be approved at least one week in advance (the earlier the better) by a SOURCE staff member. Contact source@jhsph.edu or call (410) 955-3880.

Primary Location of Event(s)

Additional info regarding location of event(s):

Frequency of event:

If you are planning a one-time, date-specific event, list the date. If you answered 'other' in the above field, please explain here:

Will parents/ guardians attend the event(s) with youth/ children?

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