Tuskegee Amnaelu Chapter DELTA SIGMA THETA SORORITY, INC. GEMS Parآ  Tuskegee Amnaelu Chapter DELTA

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  • Tuskegee Alumnae Chapter DELTA SIGMA THETA SORORITY, INC.

    Stephanie Love Newman, President Cheryl Ferguson, Chair of Program Planning and Development

    2019-2020 YOUTH INITIATIVE PROGRAMS

    Dr. Betty Shabazz Delta Academy Dr. Jeanne L. Noble GEMS Institute EMBODI “The Transformation of Me…Knowing Me, Developing Me, Preparing Me”

    “Growing and Empowering Myself Successfully” “Empowering Males to Build Opportunities for Developing Independence”

    Dr. Betty Shabazz Delta Academy was created out of an urgent sense that bold action was needed to save our young females aged 11 to 14 from the perils of academic failure, low self-esteem, and crippled futures.

    Dr. Jeanne L. Noble Delta GEMS Institute was created to "catch the dreams" of African American at-risk, adolescent girls aged 14 to 18. Delta GEMS provides the framework to actualize those dreams through the performance of specific tasks that develop a "CAN DO" attitude.

    EMBODI: Empowering Males to Build Opportunities for Developing Independence was designed to address issues facing African American males, through dialogue groups, presentations, community forums, structured activities, and mentorships.

    The three groups provide an opportunity for local Delta chapters to enrich and enhance the education that our young preteens and teens receive in schools across our city. The mission of our groups is as follows:

    ❖ The Delta Academy curriculum is centered on activities for young girls ages 11 to 14, and focuses on social and emotional development, physiological transitioning and exposure to global ideas and learning opportunities, particularly in the fields of Science, Technology, Engineering and Math (STEM).

    ❖ Delta GEMS is for teen girls in high school that is a continuation of the Delta Academy. It encourages and promotes high achievement in school by assisting the girls on goal setting and planning for the future. It provides activities for girls that create compassion, caring, and an interest in community service through various community service opportunities.

    ❖ EMBODI is our third component of Delta’s Youth Initiatives and addresses issues related to STEM education, culture, self-efficacy, leadership, physical and mental health, healthy lifestyle choices, character, ethics, relationships, college readiness, fiscal management, civic engagement, and service learning.

    A primary goal of the program is to prepare youth for full participation as leaders in the 21st Century, which will be achieved through Computer Technology, Social Skills Training, Educational Skills Training, and Field Trip(s).

    • All regular meetings are scheduled as follows: • Delta Academy - the 2nd Sunday of the month from 3:00 p.m. until 5:00 p.m. at BTW H.S. • Delta Gems – the 2nd Sunday of the month from 3:00 p.m. until 5:00 p.m. at BTW H.S. • EMBODI - TBD

    Cost: The cost of this program is FREE

    For More Information: Ms. Janet Langford, Chair – Delta Academy, (334) 202-9778 Ms. Natasha Williams, Chair – GEMS, (334) 7401-0902 Ms. Olga Bolden-Tiller, Chair – Jr. EMBODI, (334) 421-1277

    IMPORTANT DATES

  • Delta Sigma Theta Sorority, Inc. Tuskegee Alumnae Chapter

    2019-2020 DELTA YOUTH INITIATIVES APPLICATION PLEASE TYPE OR PRINT ALL INFORMATION

    Personal Information Name: (Last, First, Middle Initial) Date of Birth: Grade:

    Address: (Number, Street, Apt # if any) City/State Zip Code

    Home Telephone: ( ) Cell: ( ) E-mail Address: Parent/Legal Guardian E-mail address:School Name:

    Do you receive free or reduced lunch? YES NO Family Contact Information

    Parent/Legal Guardian Name: Cell Telephone ( ) Work Telephone: ( )

    Emergency Contact Name: Cell Telephone ( ) Work Telephone: ( ) Relationship:

    Please Check Appropriate Box for this Application: Females Only - Delta Academy (Ages 11-14) Females Only - Delta GEMS (Ages 14 -18) Males Only: Embodi (Ages 13 - 17)

    Parent/Legal Guardian Name: Signature of Consent for program participation: Date:

    This form must accompany all required forms from Delta Sigma Theta Risk Management Program - Revised Sept 2017

  • PARENT/GUARDIAN FORMS CHECKLIST

    Youth Participant Name:

    Date:

    ______ Appendix B1: Parental/Guardian Affirmation Date Received: _________________________

    ______ Appendix B2: Photograph, Media and Video Authorization Form Date Received: _________________________

    ______ Appendix B3: Youth Code of Conduct Date Received: _________________________

    ______ Appendix B4: Youth Pick-up Authorization Date Received: _________________________

    ______ Appendix B5(a): Waiver and Permission to Transport Youth Date Received: _________________________

    ______ Appendix B5(b): Parent Waiver and Permission for Teenage Driver to Transport Youth Date Received: _________________________

    ______ Appendix B6: Off-site Permission Date Received: _________________________

    ______ Appendix B7: Medical Information and Treatment Authorization Packet Date Received: _________________________

    ______ Appendix B8: Medication Authorization Date Received: _________________________

    ______ Appendix C1: Confidentiality Policy Date Received: _________________________

    ______ Appendix C2: Child Abuse Reporting Numbers Date Received: _________________________

    ______ Appendix C3: Youth Sign-In/Sign-Out Policy Date Received: _________________________

    ______ Appendix C4: Internet Use Policy Date Received: _________________________

    Printed Name of Chapter Member Completing Form: ______________________________________

    Signature: ________________________________________________

    Tuskegee Alumnae Chapter of Delta Sigma Theta Sorority, Incorporated Risk Management Manual

    Revised 02/2019

  • APPENDIX B1

    PARENTAL/GUARDIAN AFFIRMATION

    I, _____________________________________, hereby give my permission to the

    _________________________________________ Chapter of Delta Sigma Theta Sorority, Incorporated

    for ___________________________________ to participate in the

    ____________________________________ youth initiative (including planned activities), and I hereby

    attest, under penalty of perjury, that I have the legal authority to authorize such participation.

    Printed Name:

    Signature:

    Relationship to child:

    Date:

    WAIVER AND RELEASE

    I, ____________________________________, Parent/Guardian, on behalf of

    ____________________ (“Participant Minor Child”) do hereby release, waive,

    discharge, covenant not to sue and agree to hold harmless Delta Sigma Theta Sorority, Incorporated

    (“DST”), its officers, National Executive Board, employees, members, local Chapters, representatives,

    agents, affiliates, and assigns (collectively “Releases”), from any and all claims, demands, and actions

    of any and every kind directly or indirectly arising out of, or relating in any respect to Participant

    Minor Child’s participation in the __________________________________________ Youth Initiative.

    My waiver and release of all claims, demands, actions, and liability shall include without

    limitation, any injury, illness, death, property damage or loss to the Participant Minor Child which

    may be caused by any act, or failure to act, by the Releases, unless such injury, illness, death, property

    damage or loss is a direct result of the willful misconduct of any Releases.

    I understand that, without limitation of the foregoing, neither Delta, nor the Program, shall be

    liable and each is hereby released from all claims that may arise from loss or damage to the Participant

    Minor Child’s personal property.

    Parent/Guardian Signature:

    Date:

    Tuskegee Alumnae Chapter of Delta Sigma Theta Sorority, Incorporated Risk Management Manual

    Revised 02/2019

  • APPENDIX B2

    PHOTOGRAPH, MEDIA AND VIDEO AUTHORIZATION RELEASE FORM

    I/We, (“Parent/Guardian”), as parent(s) or legal guardian(s) of , give permission for _______________________ 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 during participation in Youth Initiative Program activities, without payment or any consideration and without notifying me in advance.

    I/We also give permission for the Chapter to highlight my child’s achievements and activities in efforts to promote the youth initiative program through newspapers, radio, TV, the web, DVDs, displays, brochures, and other types of media 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 ______________________________ Youth Initiative 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 Ima