YOUTH PROTECTION FORM

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certifies that it is operating all Rotary Youth programs in compliance with the Abuse and Harassment Prevention Guidelines set forth by the District 5330 and Rotary International policy. Included in this certification is a list and copies of all materials produced at the Rotary Club Level, as well as website links, promoting youth activities and programs. (Please attach if any documents below)
The Crisis services in the Rotary Club's City for rape and suicide crisis hotline, alcohol and drug awareness programs for teenagers, etc. are listed below (Proper law enforcement agencies, community services & private services). NAME OF AGENCY AND PHONE NUMBERS REQUIRED.
Please attach a list of club Rotarians who have attended a District 5330 Abuse and Harassment Training Program.
Click or drag a file to this area to upload.
We certify that all Rotarians and non-Rotarians participating as an integral part of our Rotary Club Youth Programs have undergone a background check and reference check required by Rotary International and District 5330 policy including, but not limited to, adult full-time residents of youth exchange host home, counselor, club chairs, and all Rotarians and their spouses or partners with direct unsupervised contact with students in each of our Rotary Club's youth programs. All volunteers have completed and signed the Youth Volunteer Affidavit. No volunteers have had unsupervised contact with students in the Youth Programs of our Rotary Club until a background check was conducted and each was cleared for unsupervised contact with students.
Our Rotary Club will follow the Youth Program Abuse and Harassment Reporting Guidelines established by District 5330 and Rotary International.
Rotary Club President Name
Rotary Club Youth Protection Officer's or New Generation Director's name: