Please complete and submit this form to register any program that will include minors as participants. Program Information: Name of Program * Program Objectives and Brief Description * Program Start Date * Year Year20152016201720182019 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Program End Date * Year Year20152016201720182019 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Program Website Address Name of Sponsor School or Department * Program Location/Venue (If multiple venues will be utilized, please provide an overview of the itinerary including venues with this submission, or email the itinerary to us at protectminors@stanford.edu.) Call the Stanford Conferences Office at (650) 723-3126 if you have questions. Number of Minors Anticipated to Attend Program * Age Ranges of Participants * (Check all that apply). < 6 years 6 - 8 years 9 - 13 years 14 - 17 years Sponsor Contact Information: Sponsor Contact Name * Phone No. * Email Address * Program Director/Primary Contact Information: Program Director/Primary Contact Name * Phone No. * Email Address * Submitter's Contact Information: Submitter's Contact Name * Phone No. * Email Address * By submitting this form, I certify full understanding of Stanford University’s Protection of Minors policy and agree to comply with the requirements of that policy to ensure all minors participating in University sponsored programs will remain safe during their participation. Further, the Program Director and Sponsor Contact/Representative understand that compliance with the policy must be satisfied and recorded by Stanford Conferences before the program may take place, despite any services and/or facilities bookings that may have been secured and/or any financial obligations that may have been incurred. Protection of Minors Policy
