ΔΣΘ 2016 UNMASKING THE FUTURE Jabberwock Pageant APPLICATION DEADLINE: FEBRUARY 20, 2016. PO Box 1962 Summerville, SC 29484 www.summervilledst.org Contact Nevja Wigfall 843.810.3600 with any questions regarding the application process.
P a g e 2 All materials should be received in one complete packet by FEBRUARY 20, 2016. Late applications or incomplete packets will not be considered. All Applications must include: 2016 Jabberwock Participation Agreement Parent Statement of Commitment and Responsibilities Completed Participant Application Form Two Completed Recommendation Forms Non-Refundable Application Fee of $30 (Cashier s Check or Money Order) Parental Affirmation, Waiver and Release Form Submit the completed Application Package to: Attention: Jabberwock Committee P.O. Box 1962 Summerville, SC 29484 PO Box 1962 Summerville, SC 29484
P a g e 3 PARTICIPATION AGREEMENT I,, agree to participate in the 2016 Jabberwock Program and all other required functions in conjunction with the 2016 Jabberwock program, sponsored by the Delta Sigma Theta Sorority Inc. -. I also agree to adhere to the following guidelines of the contest: 1. Pay a non-refundable, initial application fee of $30. This will cover: performance rehearsals, 1 Jabberwock ticket and any incidentals. I understand that there will be 1 winner and 2 runnersup per age group: Little Miss Jabberwock and Miss Jabberwock. 2. The understanding that awards to winners are subject to participants meeting all attendance and fundraising commitments: a. Attend a minimum of 75% of all related functions and activities held b. Fundraise a minimum of $300.00 for scholarships and programming and c. Sell a minimum of 10 tickets to the Jabberwock Program (ticket prices @ $10.00 per person) 3. Not have a child or be pregnant before and/or during the time period of the Jabberwock program. 4. Report to the Jabberwock Committee Chair immediately any disciplinary or criminal matters (suspension, expulsion requests, arrests) and understand that this might be cause for removal from the Jabberwock program and forfeiture of any monies paid or raised. 5. Maintain an active email address for program acceptance notification and updates. 6. Sign and Submit the Jabberwock Agreement and release of Liability forms (these forms should also include the signature of the parents or legal guardian). 7. Participants should only use the name or Delta Sigma Theta Sorority, Inc. in the following manner: I am participating in the Jabberwock program sponsored by the -. Participants must not use the Delta Sigma Theta symbols, name or Jabberwock name for any other purpose. If used incorrectly, participants might be disqualified from the Jabberwock Program and all monies forfeited. PO Box 1962 Summerville, SC 29484
P a g e 4 8. Unless otherwise announced, wear business casual attire, no jeans or sneakers. Details will be provided at a later date. 9. Attend all activities as scheduled from February through May 2016. General Statement of Conduct: has the right to disqualify any participant if any of the above criteria is not met and/or for inappropriate actions as determined by Summerville Alumnae Chapter. Jabberwock Participant Date Parent/Guardian Signature Date PO Box 1962 Summerville, SC 29484
P a g e 5 PARENT STATEMENT OF COMMITMENT AND RESPONSIBILITIES I, (Parent/Guardian) give permission for (hereafter Jabberwock participant ) to participate in the 2016 Jabberwock Program, including the associated planned activities. I will be responsible for all money collected from ads, patrons, and miscellaneous fundraising until it is submitted to the Delta Sigma Theta Sorority, Incorporated Summerville Alumnae Chapter (SAC). As the parent/guardian, I know that I am responsible for ensuring the completion of the participant responsibilities (listed below). I understand that falsification of any information in this application will result in a dismissal from the Jabberwock program and that any money received will NOT be refunded. I further understand that if she voluntarily withdraws from the Jabberwock program any money received from her on her behalf will NOT be refunded. I do herby grant permission to SAC to use the image of the Jabberwock participant. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs and/or video images taken of the Jabberwock participant for use in materials that include, but are not limited to, printed materials such as newsletters videos, and digital images such as those on SAC web pages. I accept that these images are the property of SAC, and I will not receive compensation for these images or the use of these images. Parent/Guardian Initials required for the following list of Participant and Family Responsibilities: Attend and participate in all required activities Transportation to and from all activities including rehearsals Assist child in the sell of all program tickets for a minimum of 10 tickets Assist child in the fundraising a minimum of $300 for scholarships and programming Provide participant with attire for the Program Adhere to any changes in Calendar or Program updates Parent/Guardian Signature Date PO Box 1962 Summerville, SC 29484
P a g e 6 PARTICIPANT APPLICATION FORM Type or print legibly in blue or black ink. ** Please complete all sections of the application and return by February 20, 2016. PERSONAL INFORMATION Name: First Middle Last Address: Street City/ State Zip Date of Birth: School: Grade: (mm/dd/yy) Home Phone: Cell Phone: Name of Parent/Guardian: Address: (If different from above) Home Phone: Cell Phone: Participant s Email Address: Parent/Guardian Email Address: Do you have any physical disabilities that will require special attention if selected?: Yes/No If yes, what accommodations are necessary: Are you a member of any of the youth programs sponsored by listed below? Dr. Betty Shabazz Delta Academy Dr. Jeanne L. Noble Delta GEMS Institute My signature below indicates that I provided truthful and complete information in this application and I understand that I might be contacted if there are questions or concerns about my application packet. Jabberwock Participant Date PO Box 1962 Summerville, SC 29484
P a g e 7 2016 Jabberwock Recommendation Form (For Teacher, Principal, Pastor, Community Person NOT Related to Applicant, or Counselor) The following student is seeking to be a participant in the s 2016 Jabberwock Pageant. Please complete the following information and return to the applicant in a sealed envelope with a signature before Monday, February 15, 2016. Late applications will not be considered. Applicant s Name (Print) 1. How long have you known the applicant? 2. In what capacity have you known the applicant? 3. Based on your knowledge of the applicant, please complete the following: Intellectual Ability Leadership Creativity and Imagination Maturity and Judgment Motivation and Initiative Personal Integrity Outstanding Good Fair Poor Ability to get along with peers Poise Please use the space below to make additional comments. (An additional sheet may be attached). Signature Date Name (Print) Title Address City State Zip Phone PO Box 1962 Summerville, SC 29484
P a g e 8 PARENTAL AFFIRMATION I,, Parent/Guardian, under penalty of perjury, do hereby affirm to the of Delta Sigma Theta Sorority, Incorporated that I authorize the participation of, Participant Minor Child, in the 2016 Jabberwock and that I have the legal authority to provide my consent and authorization for such participation. Parent/Guardian Signature: Date: Name (Print): Phone: Relationship to Participant: Address: Street City/ State Zip 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 ( Delta ), 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 2016 Jabberwock. 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 Release. 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: Name (Print): Phone: PO Box 1962 Summerville, SC 29484
P a g e 9 FINANCIAL INFORMATION Criteria for Winning: 1. Winners are determined by the highest monies raised (minimum $300), 10 Jabberwock tickets, 75% activity attendance. 2. Subject to the participant meeting all program commitments there will be 1 winner for each age group.* Miss Jabberwock will receive 15% of the money she raised First runner up will receive 10% of the money she raised Second runner up will receive 5% of the money she raised *In the event of a tie, the sorority reserves the right to alter award amounts. Souvenir Journal The souvenir program books will be developed from ads and patrons provided by each participant. The ads can come from family, friends, churches, businesses, civic organizations, etc., all giving congratulatory expressions to the participants. Fundraising Fundraising ideas can come from many sources. Funds Raised Designated times and locations will be provided to collect all monies. These dates will allow you to avoid holding checks and large sums of money. All required forms should be filled out completely and accurately. Participant s name must appear on the memo line of all checks to ensure proper processing and credit. All checks should be made payable to. Participants are responsible for ALL fees associated with any checks they submit if they are returned. The amount of the dishonored check and associated fees will be deducted from the participant s total should the issue not be resolved. PO Box 1962 Summerville, SC 29484