CampusGroups

Minors Risk Assessment Form

ASA-Student Organizations are required to complete the MIT Programs Involving Minors Risk Assessment Form at least two (2) months prior to the planned activity. In addition to completing this form, along with an event registration form on Atlas (found under the “Event Planning” section on the left-hand side of the page), you must schedule a meeting with Ana Lucena Navarro (sofia993@mit.edu) in the Student Organizations, Leadership and Engagement Office to review your program.
This meeting must take place at least one (1) month prior to their event to ensure all steps are completed in time.
Approval can only be granted by the SOLE.

Student Leader Name - Host/Planner *

Important Information about the next question. STUDENT ORGANIZATION INFORMATION

Student Organization Name: *

Important Information about the next question. STUDENT ORGANIZATION INFORMATION

Name of Student Leader(s) in charge: *

Important Information about the next question. STUDENT ORGANIZATION INFORMATION

Position and class year: *

Important Information about the next question. STUDENT ORGANIZATION INFORMATION

Contact phone number: *

Important Information about the next question. STUDENT ORGANIZATION INFORMATION

Email: *

STUDENT EVENT/ACTIVITY INFORMATION

Name of Event/Activity: *

Start and End Date of Event: *

Event Location: *

MIT Programs Involving Minors Risk Assessment Form

Estimated number of Minor Participants: *

What is the age range of participants? *

Additional instructions for the previous question. Elementary, middle, or high school students?

Will parents and/or guardians be in attendance? *

Yes

Estimated number of student staff and/or volunteers* *

Additional instructions for the previous question. *For events taking place in several classrooms/spaces, there must be 2 MIT students present
in each room. Please arrange to have enough volunteers to meet this requirement prior to
your event.

Funding source(s): *

Describe the event/activity in detail. Please include on a separate piece of paper: *

Additional instructions for the previous question. * Include a schedule of the day, emergency/evacuation and safety plans, and detailed
account of all activities during event, as well as information about how volunteers will be
interacting with minors. What best practices will you be following for volunteers? Ground
rules for participants? Also provide copies of fliers, publicity, and website information
related to the event.

Is the entire program time scheduled (minimal or no free
unsupervised time)? *

Yes

Is this a recurring event/activity? *

Yes

Additional instructions for the previous question. If yes, how often will it take place?

Comments:

Does an Institute department or office sponsor this
event/activity? *

Yes

Will volunteers who are not currently MIT-affiliated
participate in this? *

Yes

Does your group have a faculty or staff advisor for this
event/activity? *

Yes

Does this event make use of Institute equipment, labs, or
other resources? *

Yes

Is there a fee associated with this event/activity? *

Yes

Additional instructions for the previous question. If so, how much?

Comments:

Will locker rooms or other changing facilities be used? *

Yes

Will there be an initial meeting with parents prior to
event/activity? *

Yes

Additional instructions for the previous question. If yes, please describe or include what will be discussed:

Comments:

MIT Programs Involving Minors Risk Assessment Form

No member of my organization is allowed to transport minors
at any time prior to, during, or following the abovementioned event/activity. I understand that I am not allowed
to bring minors to/from public transportation and must meet
them at the building where my event is held. *

This event/activity cannot include an overnight component.
Minors are not allowed to stay in Institute property
overnight.* *Some exceptions are made, specifically for select
Admissions events and HackMIT. If you believe your event falls
under this exception, please check with us in the beginning of
your planning process *

I have already contacted Andrea Finnin at MIT Office of
Security Operations to inquire about background checks on
MIT students serving as volunteers. Andrea’s e-mail is
andreaf@mit.edu. *

MIT Police (253-1212) must be called for all medical
emergencies. Only those individuals who are currently
certified in First Aid or CPR should provide such medical
assistance. *

All participants/their parents must execute liability waivers,and receive parental consent for all components of theevent/activity. You may also be required to have participants’parents complete medical release forms depending on theactivity/event. * *

All volunteers and minors must be briefed on safety and
emergency procedures *

By signing below I verify that I have completed or reviewed
this risk assessment form and certify that the answers given
are accurate and complete *

By signing below I acknowledge I will be reaching out to backgroundcheck@mit.edu to confirm if checks are required, and if so, to start working toward meeting that requirement. *

By signing below I acknowledge I will be reaching out to sofia993@mit.edu to start working toward meeting the requirments behind liability waivers and further discuss the program. *

By signing below I verify that I have reviewed the Guidelines for programs with minors for ASA-recognized student organizations.

PLEASE REVIEW MIT GUIDELINES FOR PROGRAMS WITH MINORS *

Document: GUIDELINES_FOR_PROGRAMS_WITH_MINORS_FOR_STUDENT_ORGS_v052024