Notification Of an Event involving Minors

Office of Compliance - Notification for Events with Minors

Use this form to notify the Mines Office of Compliance of your event or program involving minors. This form should be used for Mines events on and off of campus including remote or online events that involve minors. Third party vendors hosting events on campus that involve minors should also use this form. For additional information on the policy, training, and background checks please go to the Protection of Minors page.

Instructions

Please complete this form at least twenty-one (21) days prior to your event.
For help or questions when completing this form email the Office of Compliance at minors@mines.edu or see the Protection of Minors page.

Note: If a required field is not applicable to your group, simply type N/A in that field.

Organization and Contact Information

Who is submitting this form?(Required)

a Mines program (e.g., admissions, athletic events, lab tours, open to the community events.)

a Mines student group or club (including Club Sports)

a non-university organization (e.g., a community group or rental.)

Name of person completing this form(Required)

First Last

Email(Required)

Phone(Required)

Name of Organization Sponsoring the Event(Required)

Spell Out the Full Name - No abbreviations.

Organization's Address

Needed if a non-Mines organization only

Street Address Address Line 2 City State ZIP Code

Colorado School of Mines sponsoring department or group.(Required)

Name of the sponsoring department head or director.(Required)

First Last

I attest that I have the approval of the sponsoring department head or director.(Required)

Yes

Information About Your Program

Program Title(Required)

Detailed Program Description:(Required)

Type of Activity(Required)

Daytime Activity

Overnight Activity

Both

Please list the program: dates, beginning and ending times, and frequency.(Required)

Please include both the beginning and ending times. Please note the frequency such as weekly, bi-weekly, annually, one time only.

Program Location(s)(Required)

On Campus Event: list all buildings/locations. Off Campus Event: please provide the name and address of the location (e.i., Smith Elementary School, 123 School Dr., Schoolville, CO 80000.) Remote/Online Event: Please specify and describe how contact with minors will take place.

Will this program require access to a Mines laboratory space or maker space?(Required)

Note: Minors are not allowed in machine shops.

Will this program require access to a Mines computer lab?(Required)

Additional Emergency Contacts(Required)

Please list two additional people responsible for making arrangements for the safety of the minors and other participants in the event of an emergency. For each person list: Name, Email and Phone number.

Full Name

Phone

Additional Emergency Contact - #2(Required)

Full Name

Phone

Information about the Minor Participants

Will the minors be accompanied by parents or adult chaperones?(Required)

Yes

List Minor Participants by Age Group(Required)

Please enter the number of minors in each age group. If no minors from an age group will participate enter "0".

4-5 year olds

6-9 year olds

10-11 year olds

12-15 year olds

16-17 year olds

Information about the Adult Supervisors/Volunteers

In this section you will provide information about the adult supervisors/volunteers. The Mines Policy on the Protection of Minors requires that all adults(persons over the age of 17) who will be working with minors complete a background check at least every two years. Background checks for Mines personnel participating in an event with minors will be completed by the Office of Compliance in conjunction with Human Resources. Non-Mines entities will need to complete their own background checks and provide the documentation to the Office of Compliance.

Estimated number of adult supervisors/volunteers(Required)

Participating adult supervisors/volunteers(Required)

Please list all personnel (include volunteers, contractors, students and employees) who are involved and will have contact with minors in this program. Please provide the name, CWID, email and phone number for each adult. Note: Per the Protection of Minors Policy, any individuals who have not had a background check completed in the past 24 months will be required to complete one. Self-reporting is required of any arrest/conviction posing a risk to minors. ** To add more lines, click the Plus sign on the right hand side.**