Program Registration for Groups Working with Youth/ Children (under 18) in Any Capacity You must have JavaScript enabled to use this form. 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 Affiliation with Johns Hopkins University - Select -Approved Student OrganizationPartner of Johns Hopkins University via Memorandum of Understanding or other formal agreementHopkins Faculty Led/ Advised Program, Workshop, etcJohns Hopkins University Approved PartnerOther… If you answered 'other' in the above field, please explain here: School Affiliation School Affiliation - Select -Bloomberg School of Public HealthSchool of NursingOther… If you answered 'other' in the above field, please explain here: Program Description Primary Contact(s) Information Primary Contact (Full Name) Primary Contact Phone Number Primary Contact Email Primary Contact Affiliation with Hopkins Primary Contact Affiliation with Hopkins - Select -StudentFacultyStaff / AdministrationCommunity PartnerOther… If you answered 'other' in the above field, please explain here: Secondary Contact (Full Name) Secondary Contact Cell Phone Number Secondary Contact Email Secondary Contact Affiliation Secondary Contact Affiliation - None -StudentFacultyStaff / AdministrationCommunity PartnerOther… If you answered 'other' in the above field, please explain here: 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) - Select -Johns Hopkins Bloomberg School of Public HealthJohns Hopkins School of NursingOther Johns Hopkins campus/ locationOff-campus (any non-Hopkins location)Community partner siteOther Additional info regarding location of event(s): Frequency of event: Frequency of event: - Select -One-time, specific dateDailyWeeklyMonthlyOther… If you answered 'other' in the above field, please explain here: 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? Will parents/ guardians attend the event(s) with youth/ children? - Select -Yes, at least one parent/ guardian will be in attendanceNo, no parent/ guardian will be in attendanceA parent/ guardian reguarly attends (repeat events only)A parent/ guardian attends irregularly (repeat events only)A parent/ guardian never attends (repeat events only)Other… If you answered 'other' in the above field, please explain here: CAPTCHA
