Jabberwock Program Details

Transcription

1 Jabberwock Program Details 1. What is Jabberwock? The Jabberwock is a fundraising activity for scholarship and other public service programs that begun as a unique means of raising scholarship funds. The word Jabberwock, copyrighted by Delta Sigma Theta Sorority, Inc., was taken from Lewis Carroll s tale, Alice s Adventure in Wonderland. 2. Your daughter is eligible to participate if she: NMAC Is in grades 8-12 during the academic school year.. Must be single Never married Not a parent Achieved a GPA of 2.50 or higher (Current Progress report or current transcript required) Display no tattoos, or other body piercing (excluding ear lobes, no more than one pair of earrings may be worn for the Program) Be active in school and/or community activities Sign along with parent(s) or legal guardian, the Jabberwock Statement of Commitment and Responsibilities, Submit two character letters of recommendation from a teacher, counselor or church leader (no family member) Wear required formal attire for the Jabberwock Gala and appropriate attire to other sponsored events. Have parent/guardians wear required formal attire for the Jabberwock Gala Attend a minimum of 85% of the related functions and activities held. If you are unable to attend a least 85% of activities held, you may not be allowed to participate in the event. Pay a non-refundable entry fee of $250 by September 5, Raise a minimum of $500 to be eligible for participation in the Jabberwock Gala. Each participant will be assigned a team of Delta partners to work with in forming fundraising ideas and to execute fundraising events. 3. What will your daughter receive if she participates? The Jabberwock Program Registration fee of $250 provides the participant with an exciting, fun filled learning and growing experience. The participants will receive: Orientation Manual Educational workshops Community Service Activities T-Shirt Two Mother/Daughter Event tickets Two Father/Daughter Day out tickets 4. What will your daughter receive when she raises $500 or more? Presentation and participation in the Jabberwock Gala when a minimum of $500 has been turned in to the Financial Team. Two tickets to the Jabberwock Gala. Gloves and Jewelry Accessories for the Gala Photo in Souvenir Journal Certificate of Participation Miss Jabberwock will receive 25% of her fundraising money submitted. The 1 st Place winner will receive 15% of her fundraising money submitted. The 2 nd Place winner will receive 10% of her fundraising money submitted.

2 Participant s Name Parents/Guardians Name: Address: City, Zip Home Phone #: Personal Cell Phone #: Parent/Guardian Cell Phone # Personal Address: Parent/Guardian Address Age: Grade: School: GPA: Miss Jabberwock 2015 Application Form If you are a high school senior, are you planning to attend college? Yes No If yes, where? Please list any scholastic honors you have received (include dates): Use additional sheets, if necessary. List community and church activities List the name of the individual writing recommendation letter (attach letters to the application) Sibling(s): If registering more than 1 child, $25.00 will be taken from the registration fee of each participant) Please indicate your T-shirt size XS S M L XL XXL (Print this application and return with certified check/money order to P.O. Box 24915, Nashville, TN )

3 Registration Information A registration fee of $250 and a signed Statement of Commitment and Responsibilities is required for all Jabberwock participants. Payment must be made in the form of cash, money order, or cashiers check made payable to the Fortitude Foundation, Inc. when submitting your registration packet now or no later than September 5, The Jabberwock Program Registration fee provides the participant with an exciting, fun filled learning and growing experience. Each participants will receive: If she participates: The Jabberwock Program Registration fee of $250 provides the participant with an exciting, fun filled learning and growing experience. The participants will receive: Orientation Manual Educational workshops Community Service Activities T-Shirt Two Mother/Daughter Event tickets Two Father/Daughter Day out tickets When she raises $500 or more: Presentation and participation in the Jabberwock Gala when a minimum of $500 has been turned in to the Financial Team. Two tickets to the Jabberwock Gala. Gloves and Jewelry Accessories for the Gala Photo in Souvenir Journal Certificate of Participation Miss Jabberwock will receive 25% of her fundraising money submitted. The 1 st Place winner will receive 15% of her fundraising money submitted. The 2 nd Place winner will receive 10% of her fundraising money submitted. Sibling Discount If registering more than one child in the Jabberwock Program, you will receive a $25 discount off the registration fee for each child. Upon registering for the program, please indicate this information and all of the names on the application form. Complete a separate registration packet for each sibling. Participant s Name (print) Participant s Signature: Parent/Guardian Name: (print) Parent/Guardian Signature: The Registration Fee is non-refundable and non-transferable. ** Minimum of $500 fundraising requirement for eligibility.

4 Jabberwock Participant Responsibilities Activities are planned for Participants that will encourage growth in the areas of life skills, goals setting, health, and commitment to themselves, family and community. Participants will have a memorable, fun and educational experience. 1. All Participants must realize the necessity of attendance at all planned events and activities. Your attendance will ensure that the events will be representative of you, the Fortitude Foundation, Inc. and the Nashville Metropolitan Alumnae Chapter of Delta Sigma Theta Sorority, Inc. 2. It is imperative that all Participants be punctual at all activities. 3. Attendance at the following activities is required of all Jabberwock Participants: a. Orientation b. Workshops c. Follow-up meetings d. Mother/Daughter Luncheon e. Scheduled Rehearsals f. Father/Daughter Activity g. Community Service Projects h. Career Fair i. Jabberwock Program 4. Each Participant must secure a minimum dollar amount in supporter sponsorships and patron dollars and follow the procedures for soliciting and reporting this information. The minimum dollar amount for participation in the Jabberwock Program is $ Each Participant must be an exemplary student in school and in the community. The following guidelines relative to conduct will be strictly enforced: a. A Participant expelled or suspended from school will be terminated from participation at the time this information become known to the Delta Jabberwock Team. b. NO FEES OR PAYMENTS WILL BE RETURNED. c. A Participant exhibiting unacceptable behavior that can be substantiated will be given one (1) warning. If unacceptable behavior continues, it will result in immediate termination of participation in all Jabberwock activities and program. This includes but is not limited to: i. Disruptive behavior during Jabberwock activities ii. Negative attitude or disrespect iii. Inappropriate language iv. Unacceptable behavior in school or community resulting in disciplinary action. v. NO FEES OR PAYMENTS WILL BE REFUNDED. 6. Zero Tolerance A Jabberwock Participant who exhibits substance use or abuse or has possession of a weapon will be terminated immediately from participation in all remaining activities and the Jabberwock Program. NO FEES OR PAYMENTS WILL BE RETURNED. NO FEES OR PAYMENTS WILL BE REFUNDED, IF ANY OF THE ABOVE INFRACTIONS OCCUR

5 Jabberwock Recommendation Form (For Teacher, Principal, or Counselor and Pastor or Community Person) The student identified below has expressed her interest in being a participant in the Nashville Metropolitan Alumnae Chapter s Jabberwock Program scheduled in March, A requirement of participation is to provide the chapter with character references. Therefore, please complete the following information and return it to the student in a sealed envelope. Applicant s Name (Print) 1. How long have you known this applicant? 2. In what capacity have you known the applicant? 3. Based on your knowledge of the applicant, please complete the following: Intellectual Ability Outstanding Good Fair Poor Leadership Creativity and Imagination Maturity and Judgment Motivation and Initiative Personal Integrity Ability to get along with peers Poise Please use a separate sheet to make comments. Signature Date Name (Print) Title Address City State Zip Phone # Please indicate your relation to the applicant by placing a check mark in front of the best description below: Teacher Principal Counselor Pastor Community Person not related to applicant

6 Statement of Commitment and Responsibilities I (Parent/Guardian) give permission for my child to participate in the Jabberwock Program including the planned workshops, community service projects and other activities. I will be responsible for all money collected from ads, patrons, and miscellaneous fundraising until it is submitted to the Nashville Metropolitan Alumnae Chapter. 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 Nashville Metropolitan Alumnae Chapter (NMAC) 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 NMAC 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: Attend all planned activities Transportation to and from all included activities Sell 15 Jabberwock Program tickets Raise a minimum of $500 in patrons, donations, fundraisers, etc., in order to be presented at the Gala. Provide participant with attire for the Jabberwock activities Practice prior to the Program and perform a group talent. Adhere to all changes and updates in the Jabberwock calendar. Important Information All payments are tax-deductable as allowed by the tax code and must be made payable to Fortitude Foundation, Inc. All monies received by the organization are non-refundable and non-transferable. All participants are expected to attend the community service activities and all event rehearsals. In the event of an absence, notify the Jabberwock Chairperson at least 48-hours prior to the scheduled event. Extenuating circumstances will be considered on an individual basis and should be brought to the attention of the Jabberwock Chairperson or her designee. 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) cannot participate in all activities and events. We also acknowledge that NMAC and the members involved in the Jabberwock Program are not responsible for health problems or injuries acquired during Jabberwock activities. Participant s Name (print) Participant s Signature: Parent/Guardian Name: (print) Parent/Guardian Signature:

7 Emergency Contact Form Participant s Name: Age: Grade: Parent(s)/Guardian(s): Name: Relationship: Phone#: Home Work Cell Address: Name: Relationship: Phone#: Home Work Cell Address: Other than the parents/guardians, these people have permission to pick-up my child: Name: Relationship: Phone #: Name: Relationship: Phone #: Name: Relationship: Phone #: In the event of an emergency, please contact: Emergency Contact #1: Relationship Phone #: Home Work Cell Emergency Contact #2: Relationship Phone #: Home Work Cell Health Care Provider Information: Family Physician s Name: Phone #: If your child has any of the following, please include all specific details: Allergies: Diet Restrictions/or other restrictions Other health needs or chronic health conditions: Medications my child takes for these conditions: (please list medications, dosages, and frequency taken) Does your child understand her condition and how to manage it? Yes No I acknowledge all information on this form to be factual, and affirm there are no reasons why my child cannot participate in activities. Parent s Signature: Date:

8 FIELD TRIP PERMISSION I/We, ( Parent/Guardian ), as parent(s) or legal guardian(s) of ( Child ), give permission for my/our Child to participate in the Jabberwock 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. Parent/Guardian Signature Date Parent/Guardian Signature Date

9 YOUTH PICK-UP AUTHORIZATION FORM I authorize the persons listed below to pick-up my child from the Jabberwock Program initiatives. For my child s safety, I understand that all authorized persons on the list below will be asked to show photo identification before my child is released to them; therefore, I will notify all authorized persons of this requirement so that they will have photo identification with them when they arrive to pick-up my child. (Please include names of either parents or guardians on list below). Name Relationship Home Phone Work Phone Cell Phone Name Relationship Home Phone Work Phone Cell Phone Name Relationship Home Phone Work Phone Cell Phone By signing below, I verify that I have read and agree to the Student Pick-Up policies described above and authorize the Nashville Metropolitan Alumnae Chapter to release my child to the persons listed above. I also agree to notify the Nashville Metropolitan Alumnae Chapter in writing of any changes to the above list of authorized persons. Mother/Guardian Signature Date Father/Guardian Signature Date

10 PHOTOGRAPH AND VIDEO AUTHORIZATION AND RELEASE FORM I/We, ( Parent/Guardian ), as parent(s) or legal guardian(s) of, give permission for the Nashville Metropolitan 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 Jabberwock 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 Jabberwock 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, and do hereby give my/our consent without reservation to the foregoing on behalf of my/our child. Parent/Guardian Signature Date Print Name Parent/Guardian Signature Date Print Name

11 Jabberwock Checklist Please submit this completed checklist along with the requested information. This checklist submitted with your completed registration packet and registration fee as soon as possible but no later than September 5, JABBERWOCK PARTICIPANT S NAME A. COMPLETED AND SIGNED APPLICATION FORM B. REGISTRATION INFORMATION FORM C. SIGNED STATEMENT OF COMMITMENT AND RESPONSIBILITIES FORM D. COMPLETED AND SIGNED EMERGENCY CONTACT FORM E. COMPLETED AND SIGNED FIELD TRIP PERMISSION FORM F. COMPLETED AND SIGNED YOUTH PICK-UP AUTHORIZATION FORM G. COMPLETED AND SIGNED PHOTOGRAPH AND VIDEO AUTHORIZATION AND RELEASE FORM H. TWO COMPLETED AND SIGNED RECOMMENDATION FORMS FROM A TEACHER, COUNSELOR OR CHURCH LEADER (NO FAMILY MEMBER) I. OFFICIAL SCHOOL TRANSCRIPT/REPORT CARD (MOST CURRENT) J. REGISTRATION FEE OF $250. All registration information listed above must be received in the P. O. Box by Friday, September 5, Nashville Metropolitan Alumnae Chapter P. O. Box Nashville, TN If you have questions or concerns, please us at nmacjabberwock2015@yahoo.com or contact JoAnn Johnson at or Mary Bryant at