Statement of Commitment and Responsibilities

I     Parent/Guardian *     give permission for my child to participate in the 2022-2023 Pearls & Gents of Excellence Program including the planned workshops, community service project and other activities. As the parent/guardian, I know that I am responsible for ensuring the completion of the participant responsibilities (listed below). I do hereby grant permission to San Joaquin Valley Alumnae Chapter to use video images taken of my child for use in materials that include, but may not be limited to printed materials such as newsletters, videos, and digital images. I accept that these images are the property of San Joaquin Valley Alumnae Chapter of Delta Sigma Theta Sorority Incorporated, and I will not receive compensation for these images or the use of these images.

Parent/Guardian initials are required for the following list of Participant and Family Responsibilities:
Parent's Initials *   Attend all planned activities
Parent's Initials *   Transportation to and from all included activities
Parent's Initials *   Provide participant with attire for the Pearls & Gents of Excellence Program activities , and 2023 Crimson and Cream Gala
Parent's Initials *   Practice prior to the 2023 Crimson and Cream Gala
Parent's Initials *   Adhere to all changes and updates in the Pearls & Gents of Excellence Program calendar

Important Information 
All payments must be made payable to San Joaquin Valley Alumnae Chapter of Delta Sigma Theta Sorority, Inc. All monies received by the organization are non-refundable and non-transferable. All participants are expected to attend and participate in the community service project, all workshops and event rehearsals. 

As the Participant and the parent/guardian, we have read the application packet and the list of Responsibilities and agree to follow the content as written. We affirm there are no reasons why  (Participant's Name)    First Name *     Last Name *  cannot participate in all activities and events. We also acknowledge that the San Joaquin Valley Alumnae Chapter and the members involved in the 2022-2023 Pearls & Gents of Excellence Program are not responsible for health problems or injuries acquired during Pearls & Gents of Excellence Program activities. 


Participant's Signature *    

   

FIELD TRIP PERMISSION

I/We,    Guardian's Name *         (“Parent/Guardian”), as parent(s) or legal guardian(s) of      Participant's Name *        (“Child”), give permission for my/our Child to participate in the Pearls & Gents of Excellence Program Initiatives’ (the “Initiatives”) activities taking place off site. I/we understand that transportation to and from these activities will be provided for my/our Child by the Chapter. I/We understand that the field trips are part of the Initiatives and if I/we choose to not have my/our Child participate in one or more off-site activities, I/we must make other care arrangements for my/our child during the times of that field trip activity. I/We assume all risks and hazards of loss or injury of any kind that may arise in connection with such trips, except for gross negligence or intentional infliction of harm by the Initiatives, its officers, agents or employees.

I/We do hereby agree to release and hold harmless the Initiatives, Delta Sigma Theta Sorority, Incorporated, its officers, National Executive Board, employees, members, representatives, agents and assigns from any and all claims, costs, suits, actions, judgments, and expenses for any damage, loss, or injury to my/our child or damage to my/our child’s property arising from my/our child’s participation in field trips, other than damage, loss, or injury that results from gross negligence or intentional infliction of harm by the Initiatives, Delta Sigma Theta Sorority, Incorporated, its officers, National Executive Board, employees, members, representatives, agents and assigns.


Guardian's Signature *    

PHOTOGRAPH AND VIDEO AUTHORIZATION AND RELEASE FORM

 I/We,     Guardian's Name *       (“Parent/Guardian”), as parent(s) or legal guardian(s) of    
Participant's Name *       give permission for the San Joaquin Valley Alumnae Chapter of Delta Sigma Theta Sorority, Incorporated (the “Chapter”) to publish on the Internet or media still photographs or moving images, including, if applicable any sound recordings accompanying the images (“Images”) taken of my child at the Pearls & Gents of Excellence Program without payment or any consideration and without notifying me. I/We understand and agree that these Images will become the property of the Chapter, which shall have complete ownership of the Images. I hereby irrevocably authorized the Chapter to publish or distribute these Images for the purpose of publicizing the Chapter’s programs, including the Pearls & Gents of Excellence Program or for any other lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my child’s likeness appears. Additionally, I waive any rights to royalties or other compensation arising out of or related to the use of the Images. I/We hereby hold harmless and release and forever discharge the Chapter and any of its officers and members; Delta Sigma Theta Sorority, Incorporated; its officers; National Executive Board; employees; members; representatives; agents; and assigns from any and all claims, costs, suits, actions, judgments, and expenses which my child, his/her heirs, representatives, executors, administrators, or any other persons acting on his/her behalf have or may have by reason of the use of the Images. This release specifically includes, without limitation, a complete release and discharge of any liability by virtue of any editing, distortion, alteration, or optical illusion, whether intentional or otherwise, that may occur or be produced in the taking of or editing of said Images, unless it can be shown that such was maliciously caused, produced and published solely for the purpose of subjecting my child to conspicuous ridicule, scandal, reproach, scorn and indignity. I/we hereby certify that I/we are the parents/guardians of    Participant's Name *    , and do hereby give my/our consent without reservation to the foregoing on behalf of my/our child. 

Guardian's Signature *