Minors on Campus Program Registration- Athletics

Before completing this form, please review the university policy related to Participation of Minors on Campus which can be found online at https://www.memphis.edu/universityschools/youth/

Once you have read the policy, please complete this form to register your athletics camp. Please note: you will be required to attach a certificate of insurance before submitting. Insurance requirements are posted at the link above.

Name of Program

Date(s) of Program (please note the policy requires programs to be submitted no less than 60 days in advance)

How would you categorize this program?

A University Program
A hybrid/co-hosted program (this is defined in the policy)
A third party/non-affiliated program (this is defined in the policy)

The University requires proof of comprehensive liability insurance in the amount of $1,000,000 combined single limit coverage per occurrence/($2,000,000 aggregate) For activities involving minors on campus (MOC), a sexual misconduct/molestation rider will also be required with limits not less than one million dollars ($1,000,000) combined single limit for any one occurrence/two million dollars ($2,000,000) aggregate. The University of Memphis must be named as an additional insured. Please upload a copy of your policy here. Please do not proceed with this form without including a copy of your policy that meets the insurance requirements posted online. Doing so will result in immediate dismissal of your registration and a requirement to resubmit.

Please provide a brief description of this program.

Who is the program coordinator? (this is defined in the policy) Please list name and title.

Program coordinator email address

Program coordinator cell phone number

Please list your departmental supervisor's (Dean, Director, Department head) name and email if you are a UofM employee.

Are you partnering with a university department (including your own)?

Yes
No