Skip to main content

Accessibility menu

Skip to main content Skip to footer

Forms

A page within Youth Protection

Required for ALL Programs

Program Emergency Plan

Each program is required to complete a Program Emergency Plan. If a program includes an off-campus component, additional contact information specific to the off campus location is required. The plan must include UWL's Escalation Matrix, Youth Safety and Emergency Guide, and Youth Emergency Plan Guidelines.  

Criminal Background Checks (CBC)

Activity Directors for Third-Party Non-Custodial or Custodial Youth Programs must complete the Third-Party Youth Program Acknowledgement, which attests to the completion of Criminal Background Check requirements by their volunteers. A Third-Party may rely upon their own CBC process to meet this requirement or opt to assign UWL the responsibility of completing CBC on their behalf; expenses incurred for the CBC will be charged back to the Third-Party.

Mixed Age Waiver (only if applicable)

If the program included mixed-age participants (registered individuals who are minors and others over 18), a Mixed Age Event Waiver must be completed by all adult registered participants. Minor participants in these programs must always have explicit Designated Individual supervision, with no opportunity for one-on-one interactions with any adult staff or participants. These programs are subject to a heightened supervision ratio of 1:6 for each youth participant. Additionally, mixed-age programs are expected to purchase insurance or be registered through UWL insurance with additional approval needed from Business Services.

Transportation (only if applicable)

Any transportation coordinated by UWL must adhere to minimum supervision ratios and UWL Driver Authorization Policy.

Minimum Supervision Ratios
Grade Group Program Type Designated Individuals: Youth Participants
PreK–1st: Age 3–4 University Custodial Youth Commuter Program 1:4
PreK–1st: Age 4–5 University Custodial Youth Commuter Program 1:6
PreK–1st: Age 5–6 University Custodial Youth Commuter Program 1:10
PreK–1st: Age 6 and under University Custodial Youth Overnight Program 1:4
Grades: 2nd–4th All program types   1:10
Field Trips and Overnight Programs must have a minimum of 2 adults
Grades: 5th–12th All non-classroom settings 

1:10
Field Trips must have a minimum of 2 adults
Grades: 5th–12th Classroom settings  1:18
Grades: 2nd–12th Mixed-age participants (individuals over 18 plus youth participants)  1:6


Additional requirements by program type

University Non-Custodial Youth Programs
  1. Third-Party Youth Program Acknowledgement Form
    1. The Third-Party Youth Program Acknowledgement (DocuSign version) is a signed agreement between visiting school/third-party staff and UWL that the school district or visiting third-party group will:
      1. Provide supervising staff in compliance with minimum supervision ratios
      2. Provide appropriate insurance and provide proof of insurance
      3. Perform (or has already performed) Criminal Background Checks for supervising staff
  2. Field Trip Permission Forms
    1. The visiting group is expected to have completed their own field trip permission forms with accurate details regarding the visit, as communicated with UWL (may contain non-UWL aspects in the same form).
    2. Hosting UWL employees must confirm that if off-campus trips are expected — and UWL staff will be joining for those trips (without assuming custodial care) — the third-party permission form has that explicitly mentioned.
University Custodial Youth Programs

Youth Program Staff & Participant Roster

Youth Health Form

Youth Supervision Plan Template

University Custodial Overnight Youth Programs
  1. Overnight Program Mental Wellness Safety Plan
    1. Developing an Overnight Program Mental Wellness Safety Plan is an essential step in your program development.
  2. Youth Supervision Form Template
    1. The Youth Supervision Plan must include the schedule and staffing for overnight checks
  3. Code of Conduct Forms
    1. The Overnight Program Staff Code of Conduct is required.
    2. An Overnight Program Youth Code of Conduct is highly recommended.

Overnight Program Mental Wellness Safety Plan

Youth Supervision Plan

Overnight Program Staff Code of Conduct

Overnight Program Youth Code of Conduct

Third-Party Non-Custodial Youth Programs
  1. Staff Roster
    1. A Staff Roster is required for all Third-Party Non-Custodial Programs. Additionally, Third-Party Non-Custodial Youth Programs must provide clear communication to parents/guardians indicating that:
      1. Parents/guardians are responsible for the behaviors of their children
      2. The third-party will not be responsible for supervision of minor participants

Staff Roster Template

Third-Party Custodial Youth Programs
  1. Third-Party Youth Program Acknowledgement Form
    1. The Third-Party Youth Program Acknowledgement Form (DocuSign version) is a signed agreement between visiting school/third-party staff and UWL that the school district or visiting third-party group will:
      1. Provide supervising staff in compliance with minimum supervision ratios
      2. Provide appropriate insurance and provide proof of insurance
      3. Perform (or has already performed) background checks for supervising staff
  2. Youth Program Staff & Participant Roster
    1. The Youth Program Staff & Participant Roster is shared with the Division Youth Protection Liaison (DYPL) to facilitate sharing of information regarding Criminal Background Checks (CBC) and training completion.
  3. Youth Supervision Form
    1. A Youth Supervision Plan is required for all Third-Party Custodial Youth Programs. 

Third-Party Youth Program Acknowledgement Form

Youth Program Staff & Participant Roster Template

Youth Supervision Plan Template