Register Your Program | Children on Campus

Program Registration

GENERAL PROGRAM INFORMATION

Program Name

U-M Campus

Program Abbreviation or Acronym, if any:

Program Description

Program Website, if any:

Do you wish to have this program added to the publically viewable list of registered U-M Programs?

YesNo

Sponsoring Units

Check all that apply.

Architecture & Urban Planning	Art & Design
Athletics	Business
Dentistry	Education
Engineering	Information
Kinesiology	Law
Literature, Science, and the Arts	Medical School
Music, Theatre & Dance	Natural Resources & Environment
Nursing	Pharmacy
Public Health	Public Policy
Rackham School of Graduate Studies	Social Work
Office of Government Relations	Office of the President
Office of the Provost	Office of the Vice President for Communications
Office of the Vice President for Research	Office of the Vice President for Student Life
Other

College of Arts, Sciences, and Letters	College of Business
College of Engineering and Computer Science	College of Education, Health, and Human Services
Other

College of Arts & Sciences	School of Education & Human Services
School of Health Professions & Studies	School of Management
Other

Other (Please describe.)

Is this program operated by a UM Student Organization?

YesNo

What type of Student Organization?

Sponsored (SSO)Voluntary (VSO)

Student Organization Status Definitions

VIRTUAL SESSION INFORMATION

Is this session going to be provided virtually?

What program are you going to be using (ie. Zoom, Bluejeans, etc.)?

What is the url for your video conferencing?

Will you be providing equipment to participants? (computer, laptops, etc)

Will you be providing internet access to participants?

How long will your virtual sessions be held?

How many days will your sessions be held?

PROGRAM CONTACT INFORMATION

The Primary Contact has administrative responsibility for the program and may receive inquiries from the U-M community about the program.

The Public Contact may receive inquiries from the general public about the program. The Public Contact's information may also be listed in U-M print and electronic communications.

Please provide contact information below for both primary and public contact information

Primary Program Contact

First Name

Last Name

Phone

Uniqname

Who is the Public Contact?

The Primary Contact listed aboveAnother Person is the Public Contact

Public Program Contact

First Name

Last Name

Phone

Uniqname

PROGRAM DETAILS

What are the ages/grades of minor children who are eligible to participate? (Check all that apply.)

Ages 0-2	Pre-K
Kindergarten	Grade 1
Grade 2	Grade 3
Grade 4	Grade 5
Grade 6	Grade 7
Grade 8	Grade 9
Grade 10	Grade 11
Grade 12

Approximately how many minor children are associated with this program?

Will the University be providing transportation to minor children?

YesNo

Will the University capture the names, likenesses, images, or voices of minor children in photographic, audio, video, digital or other recording forms while participating in this program?

YesNo

Will this program involve athletic activities for youth athletes?

YesNo

Does the program involve overnight stay?

YesNo

Is there a cost to minor children/families for this program?

YesNo

Is financial aid available for qualified minor children?

YesNo

Is this program open to international minor children?

YesNo

Will the program utilize adult chaperones to supervise minor children?

YesNo

What is the primary purpose of the program? (Check all that apply.)

Education/InstructionAthleticsRecruitmentChild CareHealth CareOutreach by U-M StudentsOutreach by U-M Faculty/StaffCommunity ServiceSpecial NeedsOther

Please describe.

Are the participants in this program also research subjects?

YesNoi.e., This program has received or anticipates receiving approval by U-M's Institutional Review Boards (IRB) to conduct research on program participants.

PROGRAM LOCATION

Where will the program primarily take place? (Check all that apply.)

On campusOff campusOnline

Please list the cities and states this program will occur.

Where will the program take place? (Check all that apply.)

Classrooms	Laboratories
Hospital	Residence Halls
Other Housing Facilities	Recreational Areas
Athletic Sites	Other

Please describe.

PROGRAM TIMELINE

Is advance registration/application required for this program?

YesNo

Does this program have a registration/application deadline?

YesNo

Registration/Application Deadline

When is this program offered (Check all that apply).

Fall Term (September-December)Winter Term (January-April)Spring Term (May-June)Summer Term (July-August)

Is this program typically offered annually?

YesNo

Does this program recur daily (e.g., daycare) ?

YesNo

Does this program recur over another time span (e.g., weekly or for more than one session)?

YesNo

How many times will this program recur this year (January-December)?

Please enter the date(s) of your program.

The "Start Date" should signify the first day a program is offered.
Leave "End Date" blank if this is a one day program.
If the program is offered over a span of time or for more than one session, the "End date" should signify the last date the program is offered.
The time span between "Start Date" and "End Date" should not exceed 12 months.

Start Date

End Date

ELECTRONIC FORMS PILOT

A registration link will be generated that will permit parents/guardians to complete certain Children on Campus forms electronically for in-person programs only. You may choose to use the generated registration link to capture information on the forms listed below: Note: use of the electronic forms link is not required and hard copy forms may be completed.

Participant Conduct Agreement*
Participation Agreement and Waiver (w/Chaperones and/or Transportation, if applicable)
Media, Photo & Video Release (if applicable)
State of Michigan Concussion Form (if applicable)

Additional Forms

The following forms must be completed on paper by the parent or legal guardian if they are applicable to your program: Note: The Medical Authorization to Treat Form is applicable to all programs.

Medical Authorization to Treat* (this form is required for all programs)
Over-the-Counter Medication Authorization
Self-Administration of Prescription Medication

It is the responsibility of the program to make sure that all applicable forms are completed. Paper forms should always be made available upon request.

If you would like more information regarding setting up an automated registration process customized for your program, please contact [email protected]. For more information about children on campus, please review our FAQ’s.

U-M CENTER FOR EDUCATIONAL OUTREACH

The U-M Center for Educational Outreach (CEO) shares information with U-M community partners and the public about academic outreach and enrichment opportunities available to youth through the Ann Arbor campus.

Would you like CEO to contact you about about this program?

YesNo

For more information, please contact CEO at [email protected].

Contact Information