Section Menu

Registration Packet

Program Directors must submit all necessary forms to the Designated Official (Safety and Risk Management) 30 days prior to the start of a Covered Program. Please submit all completed forms in one file/packet via email or departmental mail (3904). All forms are fillable PDF forms. If they do not open as a fillable form, you may use an alternate internet browser..

 

 

Required Registration Form

Programs for Minors Registration Form (FORM A)  This is a fillable form that can be downloaded as a PDF and saved to your computer. You may have to select "save as" in order to save it. If it is not fillable for you, you will have to "save as" and then open in Adobe to use the fill-in function. You are also welcome to hand write on the form.

In addition, one of each of these forms should be submitted for each Covered Adult

Tennessee Law on Mandatory Reporting of Child Abuse and Child Sexual Abuse acknowledgement (FORM C)

Fair Credit Reporting Act Authorization and Consent to Release Information Form (FORM H)

Government Issued Photo ID for each Covered Adult (attach this to the background check form)

Proof of Child Protection Training Completion for each Covered Adult (print training certificates and include in packet)


Optional Forms

For third party organizations only Release, Hold Harmless and Indemnification Agreement (FORM D) 

Program Directors keep these forms in their department Standards of Conduct for Covered Adults (FORM E) 


Programs that include strenuous activity

For programs that include strenuous activity, please complete these additional forms. Program Directors will keep these forms on hand:

Medical Information and Medical Treatment Release and Authorization Form (FORM B)

Authorization for Self-Administration of Prescription Medication (FORM B1)

Authorization for Dispensation of Over-the-Counter Medication (FORM B2)

Release, Hold Harmless and Indemnification Agreement (FORM D)


Request for Exception

Section 5 of SA 575 provides three exceptions to the requirements of Sections 3 and 4 of SA 575, the use of two of which requires the Program Director to complete a form and submit it to the Designated Official. A Program Director requesting the use of the first exception (“large number of volunteers”) should complete FORM F and submit it to the Designated Official in advance of the use of the exception. A Program Director requesting the use of the third exception (“exceptional circumstances”) should complete FORM G and submit it to the Designated Official after the Program Director’s use of exception.

Request for Exception to SA 575 Requirement of Criminal Background Checks and Training for Volunteers (FORM F)

Notification of Exceptional Circumstances Requiring Exception to SA 575 (FORM G)

For third party organizations only
©