DELTA SIGMA THETA SORORITY, INC. MARIETTA …€¦ · I also agree to adhere to the following guidelines of the ... maintain a professional appearance ... Delta Sigma Theta Sorority,

DELTA SIGMA THETA SORORITY, INC. MARIETTA‐ROSWELL ALUMNAE CHAPTER

Cotillion Agreement for Participation I _______________________________, agree to participate in the 2016 Debutante Ball and all other required functions in conjunction with the 2016 Cotillion that Delta Sigma Theta Sorority, Incorporated, Marietta‐Roswell Alumnae Chapter (MRAC) is sponsoring on November 19, 2016. I understand that all applications will be reviewed by MRAC and participants will be notified of their selection as a 2016 Debutante. Submit the following on Saturday, December 12, 2015:

Debutante Registration Form.

An official high school transcript.

A type written letter of interest in participating as a Debutante – Three (3) copies.

A summation of public service activities with brief descriptions of roles and responsibilities. (OPTIONAL – Required for consideration for public service award)

Three (3) letters of recommendation ‐ Preferred sources: Church, Community Organization, Teacher or Counselor.

A type written essay responding to the question – Three (3) copies:

“Identify a problem that you think is prevalent in the African‐American community. Please discuss how you think this problem should be solved and include the resources and attention you feel are necessary to solve the problem.”

Please limit your discussion to no more than two pages.

Signed copies of the Cotillion Participation Agreement, Fundraising Agreement, Agreement of Scholarship Funds Disbursement, Release of Liability Form, Code of Conduct, Health Information Form and Community Service Verification Form.

Non‐refundable entry fee of $1,000. The entry fee may be paid in two installments:

o $500 due Saturday, December 12, 2015 *

o $500 due Sunday, January 10, 2016

*If not selected as a 2016 Debutante, this amount will be returned to the Debutante.

2

2016 Debutante Cotillion

Entry fee will cover the cost for:

Two tickets to the ball (Debutante/Jr. Escort) Professional make‐up artist for portrait, pictures and ball

Two tickets to the Mother –Daughter Luncheon (Debutante and Mother)

University Campus Visit – transportation and luncheon included

Father‐Daughter Event (Deb and Sr. Escorts) Waltz Rehearsals with professional choreographer

Etiquette Workshop and Luncheon (Debutante and Jr. Escort)

College Planning Workshop with Lunch – Debutantes and Jr. Escorts

Memory gift for each activity Debutante’s Day Party (Event and Meal)

Other Monthly Activities

I also agree to adhere to the following guidelines of the Cotillion:

1. African‐American Female.

2. Demonstrate excellence in academics, exemplary moral standards and active engagement in their local community.

3. Will be High School Juniors or Seniors by September 2016.

4. Reside in the metropolitan Atlanta area.

5. Hold a minimum cumulative GPA of 2.5 on a 4.0 scale.

6. Plans to attend a post‐secondary institution/school. Scholarship funds will only be made payable to a post‐secondary institution/school. Funds will not be awarded until proof of registration is provided.

7. Wear required conservative formal attire at the ball. Specific requirements will be provided to participants at a later date.

8. Submit Junior Escort information, registration form and Code of Conduct by April 22, 2016.

9. Ensure that father/parental significant other (Senior Escort) and Junior Escort wear required conservative formal attire at the ball. Specific requirements will be provided to participants at a later date.

10. Attend at least 75% of the related functions and activities held between January 2016 and November 2016. Additional information will be provided to participants at a later date.

11. If a junior in high school, scholarships awarded will be retained by the chapter until graduation from high school. Within one year after completing high school, proof of registration in a post‐secondary institution/school must be provided for release of the scholarship funds to that institution. If a winner (junior or senior) does not attend a post‐secondary school or institution, the winner shall relinquish all rights to these funds. Funds relinquished will go into the Marietta‐Roswell Alumnae Chapter's Scholarship Fund.

3


12. Criteria for winning: There will be three (3) winners: First, Second, and Third. The Debutante, who has attended at least 75% of the activities and events (not including waltz rehearsals) and raised the most money in advertisements and donations, including having met the $2,000 minimum, will be the first place winner. The First, Second and Third place winners will receive 50%, 30% and 20% respectively of the amount of money raised. Debutantes who do not place as winners but have raised a minimum of $2,000 will receive 10% of her amount raised. ($1,000 entry fee is NOT included in the $2,000 minimum.)

13. Do Not use the name "DELTA SIGMA THETA SORORITY, DELTA SIGMA THETA SORORITY, INC. or DELTA SIGMA THETA SORORITY, INC. MARIETTA‐ROSWELL ALUMNAE CHAPTER during the solicitation of funds. If used incorrectly, the Debutante will automatically be disqualified from the Cotillion and all funds already submitted will be forfeited.

14. Sign the Cotillion Participation Agreement, Fundraising Agreement, Agreement for Disbursement of Scholarship Funds, Release From Liability Form, Code of Conduct, Health Information Form and Community Service Verification Form.

15. General Statement of Conduct: Marietta‐Roswell Alumnae Chapter (MRAC) has the right to disqualify any Debutante if the above criteria are not met and/or for inappropriate actions as determined by Marietta‐Roswell Alumnae Chapter.

SIGNATURES:

Cotillion Participant Date Chapter President Date

Parent/Legal Guardian Date Cotillion Chairperson Date

Cotillion Co‐Chairperson Date Cotillion Co‐Chairperson Date

4



Cotillion Participant Code of Conduct

The purpose of the Cotillion Participant Code of Conduct is to promote and protect the core mission of the Debutante Cotillion, to foster the academic, cultural and educational development of participants in a safe and secure environment. The Cotillion Participant Code of Conduct applies to all Debutantes and Junior Escorts participating in the Marietta‐Roswell Alumnae Chapter of Delta Sigma Theta’s Debutante Cotillion. As a condition of participation, all Debutantes and Junior Escorts must assume responsibility to observe standards of conduct that will contribute to a positive experience for all participants. That responsibility includes, but is not limited to: (a) Practicing high standards of honesty and integrity; (b) Respecting the rights, privileges, and property of other participants of the Cotillion and members of

Marietta‐Roswell Alumnae Chapter, vendors providing services to debutantes and escorts, parents, and refraining from any conduct that would interfere with Cotillion functions or endanger the health, welfare, or safety of other persons.

(c) Complying with the rules, regulations, procedures and policies as presented in the Debutante

Handbook and specifically defined in this document. Failure to comply with the Code of Conduct may result in removal from participating in Cotillion activities.

I. General Rules

(a) Debutantes/Junior Escorts should remain at Cotillion activities until the event is scheduled to end. Debutantes/Junior Escorts may not leave early without prior permission from a member of the sorority and may only be picked up from a Cotillion activity by the person designated.

(b) Debutantes/Junior Escorts should treat all others and themselves with respect. Aggressive, abusive, vulgar, or violent language and behavior towards others (ex: threats, insults, cursing, etc.) are not permitted.

(c) Debutantes/Junior Escorts should respect the property of others. Deliberate destruction or removal of property or equipment is not permitted. Financial responsibility for any damages caused by deliberate destruction will be assumed by the participant and/or parents/legal guardians. The same applies to the property and personal items of other participants.

(d) Debutantes/Junior Escorts are prohibited from possessing and/or consuming alcoholic beverages or illegal drugs.

(e) Debutantes/Junior Escorts should not possess weapons of any kind or items that could cause injury or damage to participants and/or property.

(f) Debutantes/Junior Escorts should not engage in activities that endanger the health and safety of the individual or others.

5


(g) Debutantes/Junior Escorts are not permitted to smoke and/or use any tobacco products.

(h) Debutantes/Junior Escorts must observe rules as set by the Marietta‐Roswell Alumnae Chapter.

(i) Debutantes/Junior Escorts must be present and punctual at all meetings where their involvement is required.

(j) Debutantes/Junior Escorts and Senior Escorts must be present and punctual for all waltz rehearsals with the appropriate shoes, hoop, etc.

(k) Debutantes shall observe all curfews times unless prior arrangements/communications have been made with a Cotillion Committee Co‐chairperson.

(l) Debutantes/Junior Escorts should not use electronic devices during any Cotillion activity. Electronic devices should be placed on silent or vibrate during activities/events.

II. Attire for Officially Scheduled Activities/Events**

(a) All Debutantes/Junior Escorts are expected to maintain a professional appearance during activities/events. Business attire should be worn such as dress pants, pantsuits, shirt and tie, conservative length skirts, and dresses with hosiery if necessary. Tight clothing, whether it be pants, skirts or dresses nor los‐cut blouses or necklines are appropriate and will not be accepted. All skirts must be at least fingertip length.

(b) Casual Activities – Some activities may be more relaxed where casual attire is acceptable. When casual attire is acceptable, the committee will communicate this information. Debutantes and Jr. Escorts are expected to use good judgment in selecting attire that is respectable and appropriate.

**When uncertain about attire, a committee co‐chairperson should be contacted for assistance.

III. Disciplinary Actions

(a) This Code of Conduct is binding for all Debutantes/Junior Escorts. The intent is to hold each participant accountable for his/her actions.

(b) Marietta‐Roswell Alumnae Chapter has the authority to interpret the Code of Conduct and administer any disciplinary action including suspension from an event and/or expulsion from the Cotillion and all related activities.

NOTE: Any issue not specifically covered by this Code of Conduct, but deemed inappropriate by those responsible for the Cotillion program/activity will be viewed as a violation and appropriate action will be taken. If an infraction occurs, the person in charge of the program/activity will communication appropriately to parents/guardians.

6


I have read and understand the above “Code of Conduct” and will abide by the expectations described in the Code‐of‐Conduct. I understand that if I act inappropriately I will have to accept responsibility for my actions that may result in the consequences listed above.

Participant Signature: ____________________________________ Date: ________________________

I have discussed and reviewed this Code of Conduct with my child. I understand that failure to abide by this Code of Conduct may result in the consequences listed above which includes no refund of any monies. In the event that this code is violated, I agree to come to the Cotillion activity to pick up my child at the request of the adult in charge of the program/event.

Parent/Legal Guardian Signature: ___________________________ Date: ________________________

7


MARIETTA‐ROSWELL ALUMNAE CHAPTER DELTA SIGMA THETA SORORITY, INC.

Fundraising Agreement

I ____________________________, acknowledge and understand that my daughter

___________________________ must raise a minimum of $2,000 in advertisements and/or

donations as part of the financial requirements for participating in the 2016 Debutante Cotillion.

The $2,000 minimum must be submitted by the final ad collection deadline, September 18, 2016.

I also understand that the $2,000 does not include ticket sales or the $1,000 entry fee.

I understand that ads for the Souvenir Journal are not tax deductible and all ad book checks must

be written to The Marietta‐Roswell Alumnae Chapter of Delta Sigma Theta Sorority, Inc. (MRAC).

Ad checks written to The Minerva Foundation or any other foundation will not be accepted. There

will be no exceptions.

The Marietta‐Roswell Alumnae Chapter of Delta Sigma Theta Sorority, Inc. reserves the right and

has determined that participants who do not meet the minimum $2,000 fundraising requirement

will not participate in the ball on November 19, 2016. There will be no exceptions.

I recognize and accept these terms and conditions as part of the financial requirements to

participate in the 2016 Debutante Cotillion. I understand that my daughter will not participate in

the ball on November 19, 2016 in the event that my daughter does not meet the $2,000

fundraising requirement. I understand that the fundraising requirement is in addition to the

terms outlined in the Debutante Cotillion Eligibility Requirements.

________________________________________________________________________________________________

Debutante Signature

________________________________________________________________________________________________

Parent/Legal Guardian Signature Date

8



Debutante Release from Liability

I ______________________________, give my daughter _________________________, permission to

participate in the Debutante Cotillion and all required activities and events in conjunction with the Cotillion

that is being sponsored by Delta Sigma Theta Sorority, Inc. Marietta‐Roswell Alumnae Chapter concluding

on November 19, 2016. I understand that during these activities and events in which my daughter, I or any

other member of my family participates, I will agree to release the sorority and/or chapter from all liability

should an accident occur causing injury. In the event of emergency, please contact me at:

Address:

________________________________________________________________________________ ________________________________________________________________________________ Phone Number: (_____) ____________________________________________________________ In the event of an emergency, if I cannot be reached, I authorize the person identified below to act on my behalf. Name: __________________________________________________________________________ Address: _______________________________________ Phone: (_____) _____________ ______________________________________________ Relationship to Cotillion Participant: __________________________________________________ Physician's Name and Phone Number: _____________________ Phone (____) _______________ Additional Remarks: _______________________________________________________________

____________________________________ ________________

Cotillion Participant Signature Date

_____________________________________________ _____________________

Parent/Legal Guardian Date

_____________________________________________ ______________________

Chapter President Date

_____________________________________________ ______________________

Cotillion Co‐Chairperson Date

9



Debutante Health Information

This form must be completed and signed by both the parent/legal guardian and the Debutante. The information will be kept confidential and used in the event of an emergency to assist any healthcare professional(s) with caring for the Debutante. PLEASE PRINT OR TYPE Debutante Name: _______________________________________________________________________ Last First Middle Home Address: _________________________________________________________________________ Street Address City State Zip Home Phone: (_____) _________________ Other: (_____) ____________________ Birth Date: ___________/___________/____________ Parent(s)/Legal Guardian: ________________________________________________________________________ Name Address (if different from above): ______________________________________________________________________________________ Street Address _______________________________________________________________________________________ City State Zip Home Phone: (_____) ____________ Work Phone: (_____) ___________ Other: (_____) ____________ In an emergency, if parent/legal guardian is not available notify: Emergency Contact: _______________________________________ Relationship: __________________ Name Address: _______________________________________________________________________________

Street Address City State Zip Home Phone: (_____) ____________ Work Phone: (_____) ______________Other: (_____) ________ Allergies: List all known allergies (medications, food, other). Describe reaction and management of the reaction.

10


Prohibited Foods and/or Dietary Restrictions: □ Red Meat □ Pork □ Dairy Products □ Poultry □ Seafood □Eggs □ Other (describe) _______________________________________________________________________________ ________________________________________________________________________________ Illnesses and/or Chronic Conditions: List any illnesses and/or chronic conditions that the Cotillion committee should be aware of (i.e. asthma, diabetes, seizure disorder, etc.). Please describe usual management/treatment such as medication, rest, etc.

________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Medications Currently Taken: Please list ALL medications (including over the counter or non‐prescription drugs) taken routinely or as needed. Debutantes should have enough medication with them to last the entire time of specific events. Medication should be in its original packaging/bottle that identifies the physician (if a prescription drug), the name of the medication, the dosage, and the frequency of administration. The Debutante must notify one of the Cotillion Committee co‐chairpersons that medication will need to be taken during an event/activity. □ NO medications are taken on a routine basis. OR □ Medications are taken as described below: Med #1___________________________ Dosage_____________________ Frequency______________________ Med #2___________________________ Dosage_____________________ Frequency______________________ Med #3___________________________ Dosage_____________________ Frequency______________________ Med #4___________________________ Dosage_____________________ Frequency______________________ Med #5___________________________ Dosage_____________________ Frequency______________________ *Attach additional page(s) if needed.

_______________________________________________________________________________________________

I understand that while all reasonable efforts will be made to provide a safe environment, certain risks may be involved. I understand the Marietta‐Roswell Alumnae Chapter of Delta Sigma Theta Sorority, Inc. is not liable in case of accidental injury or illness. I hereby further understand that in case of serious injury or illness, I will be notified. If it is impossible to contact me or the designated emergency contact, I hereby give permission for the Debutante as named above to receive medically necessary treatment. This health information is correct and complete to the best of my knowledge, and the Debutante herein described has permission to engage in all activities except as noted.

Signature of Parent/Guardian: _______________________________________ Date: _________________________

I also understand and agree to abide by any restrictions placed on my participation in Cotillion activities.

Signature of Debutante: _____________________________________________ Date: ________________________

11



Debutante MEDIA RELEASE FORM

I hereby consent to my child’s name, likeness, pictures or voice to be used by Marietta‐Roswell Alumnae Chapter of Delta Sigma Theta Sorority, Inc. I hereby relieve Marietta‐ Roswell Alumnae Chapter of Delta Sigma Theta Sorority, Inc. of any liability for the use of my child’s name, likeness, picture and or voice, and against any claim arising out of my child’s acts or statement during the photography session or program. ___________________________________ ____________________________ Participant Name Date ___________________________________ _____________________________ Parent/Legal Guardian Date ___________________________________ _____________________________ Cotillion Committee Co‐Chairperson Date

12



Agreement for Disbursement of Scholarship Funds

I _____________________________, acknowledge and understand that the scholarship funds

received by the First, Second and Third Place Winners will only be disbursed directly to the

university/college identified by the Debutante ______________________________.

The Marietta‐Roswell Alumnae Chapter of Delta Sigma Theta Sorority, Inc. will forward these funds

to that institution upon receipt of the Enrollment Verification form in one of two ways:

1. Disbursed to Financial Aid Office/Student Accounts

2. Placed in a recognized university/college bookstore account in student’s name.

I recognize and accept these terms and conditions for the disbursement of scholarship funds in the

event my daughter is a recipient.

_____________________________________________ ________________________

Parent/Legal Guardian Signature Date

13



Debutante Registration

Debutante Name: _________________________________________________________________________ Address: ________________________________________________________________________________ ________________________________________________________________________________________ City: _______________________________ State:________________ Zip Code: ______________ Mother/Guardian: ________________________________________________________________________ Father/Guardian: _________________________________________________________________________ Home Phone: (_______) ________________________ Debutante Mobile: (_____) ___________________ Mother Mobile: (________) _____________________ Father Mobile (_______) ____________________ Debutante Email Address: _________________________________________________________________ Mother Email Address: ____________________________________________________________________ High School: ____________________________________________________________________________ Grade Level: ____________________________________________________________________________

Extra‐curricular Activities:

14


Debutante Registration (continued) Optional Information:

How did you hear about us? _________________________________________________________ Career Interest: ____________________________________________________________________ Check all that apply:

I am/was a Delta G.E.M. Chapter: ______________________________________________

Someone in my family is a MRAC Member.

Name: ____________________________________________________________________

Relationship: _______________________________________________________________

Someone in my family is a member of Delta Sigma Theta Sorority

Name: ____________________________________________________________________

Relationship: _______________________________________________________________

15


DELTA SIGMA THETA SORORITY, INC.

A Public Service Sorority MARIETTA‐ROSWELL ALUMNAE CHAPTER

ENROLLMENT VERIFICATION FORM Cotillion Scholarship Award

Instructions:

STUDENT: Please forward this form to the proper school official (i.e., financial aid officer, registrar, bursar) to verify your current enrollment at your present institution.

Completed form should be returned to: Cotillion Committee Marietta‐Roswell Alumnae Chapter Delta Sigma Theta Sorority, Inc. P.O. Box 70786 Marietta, Georgia 30007‐0786

Scholarship funds and book stipends will be forwarded to the university/college identified for disbursement. Please provide a specific address and a person to whom the check should be mailed to.

________________________________________________________________________________________________ TO BE COMPLETED BY THE STUDENT: Name: Classification: ___________________ Home Address: ___________________________________________________________________________________ City: State: Zip code: ________________ University/ College Address: ________________________________________________________________________ Social Security Number/ Student ID: Date of Birth: ___________________ ________________________________________________________________________________________________ TO BE COMPLETED BY UNIVERSITY/ COLLEGE OFFICIAL: University/ College: _______________________________________________________________________________ Mailing Address (where check should be sent): _________________________________________________________ City: State: Zip Code: _______________ Quarter/ Semester of matriculation (please circle): Fall Winter Spring Please check: Full Time: Part Time: _______ Scholarship used for (please circle): tuition/ fees books/ supplies Special Instructions: _______________________________________________________________________________ I, , an official of (College/ University)____________________________ certify that the above named student is currently matriculating at __________________________________________.

School Seal ________ College/ University Official Signature _________________________________________

Title Date

16


KEY CONTACT INFORMATION

Name E‐mail Address Cell Phone

Bonnie Jones

[email protected] (678) 806‐8003

Lucinda Mills Co‐Chairperson


Lotatia Stewart Co‐Chairperson


17


JUNIOR ESCORT FORMS

18



Cotillion Participant Code of Conduct (Junior Escort)

The purpose of the Cotillion Participant Code of Conduct is to promote and protect the core mission of the Debutante Cotillion, to foster the academic, cultural and educational development of participants in a safe and secure environment. The Cotillion Participant Code of Conduct applies to all Debutantes and Junior Escorts participating in the Marietta‐Roswell Alumnae Chapter of Delta Sigma Theta’s Debutante Cotillion. As a condition of participation, all Debutantes and Junior Escorts must assume responsibility to observe standards of conduct that will contribute to a positive experience for all participants. That responsibility includes, but is not limited to:

(a) Practicing high standards of honesty and integrity;

(b) Respecting the rights, privileges, and property of other participants of the Cotillion and members of Marietta‐Roswell Alumnae Chapter, vendors providing services to debutantes and escorts, parents, and refraining from any conduct that would interfere with Cotillion functions or endanger the health, welfare, or safety of other persons.

(c) Complying with the rules, regulations, procedures and policies as presented in the Debutante Handbook and specifically defined in this document.

Failure to comply with the Code of Conduct may result in removal from participating in Cotillion activities.

I. General Rules

(d) Debutantes/Junior Escorts should remain at Cotillion activities until the event is scheduled to end. Debutantes/Junior Escorts may not leave early without prior permission from a member of the sorority and may only be picked up from a Cotillion activity by the person designated.

(e) Debutantes/Junior Escorts should treat all others and themselves with respect. Aggressive, abusive, vulgar, or violent language and behavior towards others (ex: threats, insults, cursing, etc.) are not permitted.

(f) Debutantes/Junior Escorts should respect the property of others. Deliberate destruction or removal of property or equipment is not permitted. Financial responsibility for any damages caused by deliberate destruction will be assumed by the participant and/or parents/legal guardians. The same applies to the property and personal items of other participants.

(g) Debutantes/Junior Escorts are prohibited from possessing and/or consuming alcoholic beverages or illegal drugs.

(h) Debutantes/Junior Escorts should not possess weapons of any kind or items that could cause injury or damage to participants and/or property.

(i) Debutantes/Junior Escorts should not engage in activities that endanger the health and safety of the individual or others.

19


(j) Debutantes/Junior Escorts are not permitted to smoke and/or use any tobacco products.

(k) Debutantes/Junior Escorts must observe rules as set by the Marietta‐Roswell Alumnae Chapter.

(l) Debutantes/Junior Escorts must be present and punctual at all meetings where their involvement is required.

(m) Debutantes/Junior Escorts and Senior Escorts must be present and punctual for all waltz rehearsals with the appropriate shoes, hoop, etc.

(n) Debutantes shall observe all curfews and be in their assigned sleeping rooms at the established curfew times unless prior arrangements/communications have been made with a Cotillion Committee Co‐chairperson (i.e. during college campus tour).

(o) Debutantes/Junior Escorts should not use electronic devices (such as cell phones, two‐way pagers, pagers, etc.) during any Cotillion activity. Electronic devices should be placed on silent or vibrate during activities/events.

II. Attire for Officially Scheduled Activities/Events**

(p) All Debutantes/Junior Escorts are expected to maintain a professional appearance during activities/events. Business attire should be worn such as dress pants, pantsuits, shirt and tie, conservative length skirts, and dresses with hosiery if necessary. Tight clothing, whether it be pants, skirts or dresses nor los‐cut blouses or necklines are appropriate and will not be accepted.

(q) Casual Activities – Some activities may be more relaxed where casual attire is acceptable (such as the Lock‐In). When casual attire is acceptable, the committee will communicate this information. Debutantes and Jr. Escorts are expected to use good judgment in selecting attire that is respectable and appropriate.

**When uncertain about attire, a committee co‐chairperson should be contacted for assistance.**

III. Disciplinary Actions

(r) This Code of Conduct is binding for all Debutantes/Junior Escorts. The intent is to hold each participant accountable for his/her actions.

(s) Marietta‐Roswell Alumnae Chapter has the authority to interpret the Code of Conduct and administer any disciplinary action including suspension from an event and/or expulsion from the Cotillion and all related activities.

NOTE: Any issue not specifically covered by this Code of Conduct, but deemed inappropriate by those responsible for the Cotillion program/activity will be viewed as a violation and appropriate action will be taken. If an infraction occurs, the person in charge of the program/activity will communication appropriately to parents/guardians.

_______________________________________________________________________________________

I have read and understand the above “Code of Conduct” and will abide by the expectations described in the Code‐of‐Conduct. I understand that if I act inappropriately I will have to accept responsibility for my actions that may result in the consequences listed above.

Participant Signature: ____________________________________ Date: _______________________

20


I have discussed and reviewed this Code of Conduct with my child. I understand that failure to abide by this Code of Conduct may result in the consequences listed above which includes no refund of any monies. In the event that this code is violated, I agree to come to the Cotillion activity to pick up my child at the request of the adult in charge of the program/event.

Parent/Legal Guardian Signature: ___________________________ Date:________________________

21



Junior Escort Registration

(To be submitted by April 22, 2016)

DEBUTANTE NAME: ______________________________________________________________ JUNIOR ESCORT INFORMATION:

Name: ____________________________________________________________________ Address: ___________________________________________________________________ __________________________________________________________________________

Home Phone: (_______) _________________ Escort Cell Phone: (______) ______________ Escort Email Address: ________________________________________________________ School: _______________________________________ Grade: ____________________

Extra‐Curricular Activities:

Escort Parent/Guardian Information: Mother/Guardian:________________________ Father/Guardian: _________________ Mother/Guardian Phone : (____) _____________ Father/Guardian Phone: (___) _______

Mother Email Address: _______________________________________________________ Father Email Address: ________________________________________________________

**Junior Escorts are also required to complete and sign a Code of Conduct, Release from Liability and Media Release Forms.

22


MARIETTA‐ROSWELL ALUMNAE CHAPTER

DELTA SIGMA THETA SORORITY, INC.

Junior Escort RELEASE FROM LIABILITY

I ______________________________, give my son _____________________________, permission to participate in the Debutante Cotillion and all required activities and events in conjunction with the Cotillion that is being sponsored by Delta Sigma Theta Sorority, Inc. Marietta‐Roswell Alumnae Chapter concluding on November 19, 2016. I understand that during these activities and events in which my son participates, I will agree to release the sorority and/or chapter from all liability should an accident occur causing injury. In the event of emergency, please contact me at:

Address: _________________________________________________________________________ Phone Number: ___________________________________________________________________ In the event of an emergency, if I cannot be reached, I authorize the person identified below to act on my behalf. Name: __________________________________________________________________________ Address: _______________________________________ Phone: __________________________ Relationship to Debutante: __________________________________________________________ Physician's Name ____________________ Phone Number: (______) _________________ Food Allergies: ____________________________________________________________________ Medications presently taking: ________________________________________________________ Additional Remarks: _______________________________________________________________

_____________________________________ __________________________

Cotillion Participant Date

____________________________________________ _______________________________

Parent/Legal Guardian Date

____________________________________________ _______________________________

Chapter President Date

___________________________________________ _______________________________

Cotillion Chairperson /Co‐Chairperson Date

23



Junior Escort MEDIA RELEASE FORM

I hereby consent to my child’s name, likeness, pictures or voice to be used by Marietta‐Roswell Alumnae Chapter of Delta Sigma Theta Sorority, Inc. I hereby relieve Marietta‐ Roswell Alumnae Chapter of Delta Sigma Theta Sorority, Inc. of any liability for the use of my child’s name, likeness, picture and or voice, and against any claim arising out of my child’s acts or statement during the photography session or program.

___________________________________ ____________________________ Participant Name Date ___________________________________ _____________________________ Parent/Legal Guardian Date ___________________________________ _____________________________ Cotillion Committee Co‐Chairperson Date

Documents

DELTA SIGMA THETA SORORITY, INC. MARIETTA …€¦ · I also agree to adhere to the following guidelines of the ... maintain a professional appearance ... Delta Sigma Theta Sorority,