Dear Parent/Guardian:

Transcription

1 Dear Parent/Guardian: The of Delta Sigma Theta Sorority, Incorporated, invites you and your teenager to join our E.M.B.O.D.I (Empowering Males to Build Opportunities for Developing Independence) youth initiative program for male participants, ages The young men will participant in interactive workshops, community service and informative activities at no cost to you. We are excited about the wonderful opportunity for your son, grandson or nephew to experience the program with men and women leaders in our community and to gain a lasting investment in his future. Each program activity will involve topics to explore areas in civic engagement, cultural awareness, leadership, education and career choices. It is the goal of the program to: Inspire discussion concerning current events affecting the male African-American population. Elevate interest in skill building and community service opportunities. Provide awareness of various career and college options. Encourage young male African- American participants to cultivate a positive vision for their future. If you would like your male teenager to join EMBODI for the upcoming session, please complete the application online at and return the two-page registration packet via USPS to, P.O. Box 370, Memphis, Tennessee, or scan and return via correspondence to macembodi@gmail.com no later than Tuesday, April 25, The EMBODI initiative will continue with our spring conference, Within Me There Is a Man, on Saturday, April 29, 2017 from 12 noon-5 p.m. at Southwest TN Community College located at 5983 Macon Cove, Memphis, Tennessee, Also, visit our website, to view the program activities sessions and dates. Sincerely, Monique Williams EMBODI Chair Tori Mason EMDODI Co-Chair

2 Student's Information Name (Last, First, Middle Initial) of Birth Age Address City/State Zip Code Home Phone ( ) Cell Phone ( ) Student's Address Current School: School Enrollment Grade: Family/Contact Information Parent/Legal Guardian Name Cell Phone ( ) Parent's Address Address (if different from above) Please indicate your preferred method of contact Phone Call ( ) Text Message ( ) ( ) Emergency Contact Name #1 Telephone: Relationship to Student Emergency Contact Name #2 Telephone: Relationship to Student Hospital Preference in case of emergency: Parental/Legal Guardian Release: I hereby release of Delta Sigma Theta Sorority, Inc., and the Grand Chapter of Delta Sigma Theta Sorority, Inc., of any and all liability relating to any physical injury or accidents which may occur as a result of my child s direct or indirect participation in activities or events conducted under the supervision and direction of Delta Sigma Theta Sorority, Inc. In the event reasonable attempts to reach me are unsuccessful, I hereby give my consent for emergency first aid or medical treatment to be administered to my child. Furthermore, I agree to release of Delta Sigma Theta Sorority, Inc., and the Grand Chapter of Delta Sigma Theta Sorority, Inc., from any and all liability associated with the emergency care and treatment of my child. I give permission for my child to be a participant of the EMBODI program hosted by the Memphis Alumnae Chapter of Delta Sigma Theta Sorority, Inc.

3 Parent/Legal Guardian Signature: : / / PARENT MEDICAL/TRANSPORTATION CONSENT FORM Participant Name: Parent/Guardian Name: Relationship: List any food allergies (example: nuts, seafood): List any medications, medical conditions (example: asthma, nose bleeds, diabetes) or physical limitations that the EMBODI committee members should be aware of: By my signature, I hereby verify that the above information is accurate. I agree to provide transportation for my child to all scheduled activities and events. I also agree to facilitate and support my child s timely attendance and participation. Parent/Guardian s Signature MEDIA RELEASE I, the parent/guardian of (print participant s name) consent to the release of photographs, videos, audio and other related recorded materials captured during the program s activities. Such materials shall remain the sole property of the of Delta Sigma Theta. Sorority, Inc. EMBODI and shall not be sold to any entity. I further understand and agree that these materials may be kept on file and used by MAC and/or Delta EMBODI for potential future use in perpetuity. I agree to release the MAC and/or Delta EMBODI from any and all liability arising from or in connection with the taking, use, publication, or dissemination of such materials. Copies of these photos may be distributed to the parent upon request. By my signature, I am indicating that I have read and understand the foregoing information.

4 Participant s Signature Parent/Guardian s Signature CODE OF CONDUCT FORM 1. Respect all participants (other youths and adult volunteers) by not using foul, hurtful or obscene language or engaging in physical violence, bullying (including cyber-bullying) or other aggressive behaviors that threaten the safety and well-being of others. 2. In the event I must miss an event, I will contact a member of the Delta E.M.B.O.D.I committee at least 24 hours prior to the activity. 3. Assume full responsibility for all personal belongings (please leave valuables at home) and respect the property rights of others. This means do not damage or deface the building or property within the building where program activities are held; do not damage or take the personal property of any other participant or volunteer; and do not use Delta s name or any symbol or logo (Delta s intellectual property) on any clothing, books, bags, other items, or on social media sites. 4. Return supplies to their proper place after using them and clean up all work areas properly. 5. Listen carefully to directions and when someone else is talking. 6. Stay within the program s designated areas within the building. 7. Cooperate and participate in organized activities. 8. Do not bring any weapons, cigarettes/drugs, alcohol, or other illegal items to any activity at any time. Such usage during the activity may result in immediate dismissal from the program. 9. Observe all safety regulations established for programs, recreational, and personal activities. I affirm that my registration information is correct, including all known allergies, dietary considerations, and routine medicines. I will report immediately all injuries or illness to the adult in charge of the activity. 10. I understand that I will receive two warnings for unacceptable behavior. After two warnings, my parent/guardian will be notified. I understand if I am sent home early due to any misconduct, it will be my parent/guardian s responsibility to provide transportation.

5 11. I will remember that I am a member of a program sponsored by the members of Memphis Alumnae Chapter of Delta Sigma Theta Sorority, Inc. and I must abide by a high standard of conduct. My behavior will reflect the high values and expectations for conduct described in this code of conduct and lady like etiquette. SANCTIONS FOR VIOLATING THE CODE OF CONDUCT Bad Language/Abusive Teasing and Related Acts: Physical Violence and Other Misconduct: 1st Time: Verbal warning issued, participant removed from the situation, and parent/ guardian notified of the incident 2nd Time: Loss of privileges 3rd Time: Dismissal from program Illegal Substances or Dangerous Weapons 1st Time: Youth is removed from the program. If a youth is in possession of an illegal substance or dangerous weapon, the police will be notified as well. With my parent/guardian, I have read the Code of Conduct and sanctions for violating the Code of Conduct. I understand the Code of Conduct and the sanctions. I will follow the Code of Conduct. Print Name Signature / / I have read and understand the Code of Conduct and sanctions for violating the Code of Conduct. I understand that my child s compliance with the Code of Conduct is a condition of her/his participation in the Delta G.E.M.S Program. I agree that the sanctions for violating the Code of Conduct are reasonable and will help my child comply. Print Name Signature / /