2025-26 Delta GEMS Application

Crowned & Rooted in the Valley Cotillion & Beautillion
Application Package 2025-2026

Dear Crowned and Rooted applicant:
We are so happy that you have expressed interest in the Inaugural Crowned and Rooted in the Valley Cotillion and Beautillion (CRVCB) hosted by the San Fernando Valley Alumnae Chapter of Delta Sigma Theta Sorority, Inc. This program is the ONLY cotillion/beautillion in the San Fernando Valley dedicated to elevating and celebrating of high school juniors and seniors, both boys and girls.

Participating in Crowned and Rooted means that you are dedicated to strive for leadership, academic excellence, and service to your current community and beyond. Through a 6 month program, we will guide you through sharpening your etiquette, heightening your presence, preparing for life after high school, and building healthy relationships.

Please review the contents of this application and submit your completed packet by the application extended due date November 30, 2025.

A completed application must be submitted by the deadline or the application will not be considered.

If you are selected to participate in the Crowned and Rooted in the Valley Cotillion and Beautillion, you will be contacted by no later than December 7th, 2025. Payment will be due December 14 at 5pm via money order or cashier's check.

If you have any questions regarding the application, please do not hesitate to contact the CRVCB committee chairs at sfvacrownedandrooted@gmail.com

Sincerely,
Crowned and Rooted Committee

Delta Sigma Theta Sorority, Incorporated, is a non-profit global organization, whose purpose is to provide services and programs that promote human welfare. The primary focus of Crowned and Rooted in the Valley is to elevate and celebrate high school junior and senior boys and girls, introduce them to society through an upscale gala, while instilling in them the greater purpose of service, leadership, and academics.

The goals & mission for the CRVCB program are:
● To create a highly desirable cultural tradition in the San Fernando Valley that is currently absent.
● To celebrate and recognize the milestones and accomplishments of high school juniors and seniors, as well as their forthcoming contributions to society.
● To foster an environment that allows for emotional growth, self reflection, and education regarding mental health skills.
● To help participants gain confidence.
● To develop, celebrate, and empower young men and women in cultural pride, & life skills.

The Tentative Dates for Crowned and Rooted sessions are as follows:
- November 9, 2025 (4:30pm-9pm) - Session 1 & Rehearsal
- December 14, 2025 (5pm-9pm) - Session 2, Headshots, & Rehearsal
- January 11, 2026 (4:30pm-7pm) - Rehearsal
- January 18, 2026 (3pm-6pm) - Mother/Daughter Tea & Father/Son Gentlemen's Lounge
- February 7, 2026 (8am-12pm) - Community Service
- February 7, 2026 (7pm-9pm) - Rehearsal
- March 1, 2026 (4:30pm-9pm)- Session 4 & Rehearsal
- March 14, 2026 (6pm-9pm) - Rehearsal
- April 12, 2026 (4:30pm-7:30pm)- Clothing Try-On & Rehearsal
- April 19, 2026 (all day) - Special Outing
- April 24, 2026 - Final Rehearsal
- April 26, 2026 (all day) - Cotilliion/Beautillion Presentation
All dates and locations are subject to change. You will be given notice of such changes in a timely manner.

EXPECTATIONS

Attendance:

Crowned and Rooted in the Valley Cotillion and Beautillion requires dedication and commitment not only to the high school seniors and juniors who are selected but also from the parental/guardians. The parent/guardian is intrical to the success of this program and a requirement. All sessions are mandatory. Please look over the calendar we have provided closely. Only 2 excused absenses will be allowed during the program before potential removal without refund will be considered.

Financial Obligations:

There are 3 financial components to our program.
1. The Program Fee is $1650. The fee helps to cover many of the expenses for each Deb and Gent. This fee is due in full by October 24th via money order or cashier check.
2. The Souvenier Booklet Ad Sale minimum requirement is $2500 per Deb and Gent. These sales partially turn into scholarships for those participants that reach the minimum in sales. Those that are our top sellers will receive a larger scholarship and award. The deadline for receiving the ads will be forthcoming in 2026.
3. Ticket sales to the Gala is set to 8 tickets per participant. The ticket price is $175 per ticket*. We encourage you to purchase all your tickets upfront and then resell them to your friends and family members to guarantee your entire party sits together. *Ticket price will be finalized at a later date.
4. The Escort Fee is $375. This will cover the escorts' attire for the program gala. This fee is due in full by October 24th via money order or cashier check.

Section 2: Applicant Questions
List Any Leadership Positions You've Held While In High School*
List Any Honors, Awards, and Achievements You've Received While In High School*
List Any of Your Special Talents and Hobbies.*
List All Community Service hours completed in the past 12 months, the organization in which the hours were completed, and a contact person for the organization*

Section 3: Video and Report Card Submissions
Please Upload a 2-3 minute video MAX, answering ONE of the following questions: Why do you want to be celebrated? OR How do you make a space better when you leave it?

Browse Files
mp4, mv4, or mov files Cancelof
Upload a copy of your report card representing the end of the 2024-2025 school year. Please make sure the image is clear.

Browse Files
pdf or jpg Cancelof

Section 4: Escort Questions
Why do you want to be an escort?*
Name your school and extracurricular activities.*

Section 5: Parent Information

Sections 5-11 should be completed by the applicant's parent/guardian.
Parent/Legal Guardian's Name:*

First NameLast NameSuffix
Parent/Legal Guardian's Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Legal Guardian's Email Address:*
example@example.com
Parent/Legal Guardian's Primary Phone Number:*

Area CodePhone Number
Relationship
Add additional Parent/Legal Guardian*

YesNo
Secondary Parent/Legal Guardian's Name:

First NameLast Name
Secondary Parent/Legal Guardian's Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Parent/Legal Guardian's Email:
example@example.com
Secondary Parent/Legal Guardian's Phone Primary Number:

Area CodePhone Number
Relationship
What is something you would like for your Debutante, Gentleman, or Escort to learn or take away from the program this year?
Signature

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By my signature below, I hereby verify that the above information is accurate. My signature grants permission for my child to participate in the Crowned and Rooted in the Valley Cotillion/Beautillion, field trips, and activities therein. In giving my permission to participate, I understand that she/he will take part in scheduled meetings, workshops, cultural, educational and recreational programs. I agree to provide transportation for my child to all scheduled meetings and activities. I also agree to facilitate and support my child’s timely attendance and participation. **Missing 2 meetings will potentially forfeit your child's participation in the CRCBV Program**

Section 6: Consent & Authorization Forms

This section should be completed by the applicant's parent/guardian.
Parent/Guardian Statement of Consent
I voluntarily give my child (the student whose name is listed on this application) permission to participate in Crowned and Rooted in the Valley Cotillion/Beautillion. I am authorized to give permission for the student to participate in the program. My child’s participation in CRVCB is completely voluntary. Crowned and Rooted in the Valley Cotillion/Beautillion is committed to providing the best possible climate for maximum development and achievement of goals for all student participants. The San Fernando Valley Alumnae Chapter of Delta Sigma Theta Sorority, Inc. and its related entities will make every effort to protect the welfare of the Crowned and Rooted in the Valley Cotillion/Beautillion participants; however, the program committee members are not responsible for ensuring the physical, mental, social, and medical health of program participants. As a parent/guardian, I am responsible for the welfare of my child. The Crowned and Rooted in the Valley Cotillion/Beautillion committee may suspend a student’s participation if his/her behavior does not reflect the spirit of the program.*

Yes, I give my child permission to participate in the Crowned and Rooted in the Valley Cotillion/Beautillion program.No, I do not give my child permission to participate in the Crowned and Rooted in the Valley Cotillion/Beautillion program
Crowned and Rooted in the Valley Cotillion & Beautillion Participant Sign In/Sign Out Consent
I, as parent or legal guardian, do hereby release, waive, discharge, covenant not to sue and agree to hold harmless Delta Sigma Theta Sorority, Incorporated, its officers, National Executive Board, employees, members, local chapters, representatives, agents, affiliates, and assigns, from any and all claims, demands, and actions of any and every kind directly or indirectly arising out of, or relating in any respect my child’s participation in Crowned and Rooted in the Valley Cotillion/Beautillion. My waiver and release of all claims, demands, actions, and liability shall include without limitation, any injury, illness, death, property damage, or loss to my child, which may be caused by any act or failure to act by the Crowned and Rooted in the Valley Cotillion/Beautillion program, unless such injury, illness, death, property damage or loss is a direct result of willful misconduct. I understand that, without limitation of the foregoing, neither Delta Sigma Theta Sorority, Incorporated, nor the Crowned and Rooted in the Valley Cotillion/Beautillion program, shall be liable and each is hereby released from all claims that may arise from loss or damage to my child’s personal property.*

Yes, I give my child permission to sign his/herself in and out of Crowned and Rooted in the Valley Cotillion/Beautillion meetings and activities.No, I do not give my child permission to sign his/herself in and out of Crowned and Rooted in the Valley Cotillion/Beautillion meetings and activities.

Section 7: Consent & Authorizations
Pick Up Authorization Form
Please disclose the name(s), home/work/cell phone numbers and the relationship that the person(s) you wish to be authorized to pick up your child below.*
Signature Parental Acknowledgement

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I authorize the persons listed below to pick-up my child from the Crowned and Rooted in the Valley Cotillion/Beautillion program. 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. By signing below, I verify that I have read and agree to the Student Pick-Up policies described above and authorize the San Fernando Valley Alumnae Chapter to release my child to the persons listed above. I also agree to notify the San Fernando Valley Alumnae Chapter in writing of any changes to the above list of authorized persons.

Section 8: Code of Conduct

This section should be completed by both the applicant & applicant's parent/guardian.
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 of others.
2. Respect the property rights of other. This means do not damage or deface the building or property within the building where chapter 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, or other items.
3. Return supplies to their proper place after using them.
4. Clean up all work areas properly.
5. Listen carefully to directions and when someone else is talking.
6. Respect designated quiet areas, such as homework/reading area.
7. Stay within the program’s designated areas within the building.
8. Cooperate and participate in organized activities.
9. Assume full responsibility for all personal belongings. Please leave valuables at home.
10. Do not bring any weapons, cigarettes/drugs, alcohol, or anything illegal to any activity at any time.
PARTICIPATING IN YOUTH INITIATIVES PROGRAM
Bad Language/Abusive Teasing and Related Acts:

1st Time: Verbal warning, parent or guardian notified from this point forward

2nd Time: Loss of privileges

3rd Time: 1-day suspension from program

4th Time: 1-week suspension from program

Next occurrence youth is removed from the program.

Physical Violence and Other Misconduct:

1st Time: Removal from situation, loss of privileges, guardian notified from this point forward

2nd Time: 1-day suspension from program

3rd Time: 1-week suspension from program

Next occurrence youth is removed from the 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.

Cyber-bullying is defined in Appendix 16, which sets out the Internet Use Policy.

With my parent or other adult, I have read the Code of Conduct and sanctions for violating the Code. I understand the Code and the sanctions. I will follow the Code of Conduct.
Participant Signature:

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With my parent or other adult, I have read the Code of Conduct and sanctions for violating the Code. I understand the Code and the sanctions. I will follow the Code of Conduct.
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 Crowned and Rooted in the Valley Cotillion/Beautillion program. I agree that the sanctions for violating the Code of Conduct are reasonable and will help my child comply.
Parent or Guardian Participant Signature:

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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 Crowned and Rooted in the Valley Cotillion/Beautillion program. I agree that the sanctions for violating the Code of Conduct are reasonable and will help my child comply.

Section 9: Participant Agreements
Virtual Meeting/Event Participant Agreement
I, {parentlegalGuardians54} (“Parent/Guardian”), as Parent or legal Guardian of {applicantName} give permission for Delta Sigma Theta Sorority, Incorporated (the “Sorority”) and the Chapter of Delta Sigma Theta Sorority, Incorporated (the “Chapter”), to host and facilitate closed virtual meetings/events using Zoom (the “Virtual Meeting Platform”), that my child will attend during participation in the Youth Initiative Program activities, without payment or any consideration and without notifying me in advance and hereby acknowledge, understand, and agree to the terms enumerated below, including the terms set forth on any Schedules attached hereto and incorporated by reference (the "Participant Agreement").

I also understand that the Virtual Meeting Platform may collect information about its users and has its own privacy terms and conditions to which users must adhere. I will be responsible for reviewing the Virtual Meeting Platform’s privacy terms and conditions before registering for virtual meetings/events. I also understand that my child will need the following to participate in a Virtual Meeting Platform:

A computer, mobile, or tablet device with access to the Internet
A quiet space in which participants can participate in the virtual meeting/event under the supervision of an adult Registration for the virtual meeting/event platform and provide some customer data (including but not limited to an email address, first and last name, etc.)

I also understand, acknowledge and agree to indemnify, defend, protect and hold harmless the Chapter and any of its officers and members; and the Sorority and any of its officers; National Executive Board; employees; members; representatives; agents; and assigns from and against any and all liability, whether in law or in equity, should there a breach of security of the Virtual Meeting Platform and any subsequent injury, malice, or harm that might occur as a result, and waive and release any and all rights with respect to the same.

I hereby hold harmless and release and forever discharge the Chapter and any of its officers and members; and the Sorority; 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 virtual meeting platform as a venue for meetings or events. 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 and content of the virtual meeting/event, 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 hereby certify that I am the Parent/Guardian and is authorized legally to give this consent, and do hereby give my consent without reservation to the foregoing behalf of my child.

I have fully read and understand 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 program. I further acknowledge, understand, and agree that the sanctions for violating the Code of Conduct are reasonable and should my child be non- compliant, they will be subject to the prescribed disciplinary action. I also give permission for the Chapter and the Sorority to highlight my child’s achievements and activities in efforts to promote the youth initiative program through the virtual meeting platform that will include the use of still photographs, moving images or live images, and chats including, if applicable any sound recordings accompanying the images (“Images”) taken of my child or provided by my child during participation in Youth Initiative Program in accordance with the terms set forth in the Media and Publication Releases.

Section 10: Medical and Emergency Contact Information

Please fill out this portion of the application in its entirety. Thank you for your cooperation.
Name of Insured:*

First NameLast NameSuffix
Date of Birth:*

MonthDayYear
Date
Name of Physician:*
Physician's Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Physician's Phone Number:*

Area CodePhone Number
Does your child take prescription medication? If yes, what is the medication and the frequency taken. If no, put N/A. *
Does your child take over the counter medication? If yes, what is the medication and the frequency taken. If no, put N/A.*
Does your child have any allergies to foods? Please specify below, or write N/A?*
Does your child have any allergies to medicines? Please specify below, or write N/A*
Does your child have any allergies to bee stings or insect bites? Please specify below, or write N/A*
Are there any other conditions, accommodations, or restrictions required? Please specify below or write N/A here.*
Participant's Health and Medical Emergency Information/Authorization

For any medications or treatment required during the course of the Crowned and Rooted in the Valley Cotillion/Beautillion program, the Parent/Guardian may stay or return to administer any required medications to a youth participant if the Parent/Guardian does not want their child to self-medicate. If for any reason you the Parent/Guardian cannot be reached, please fill out the emergency contact information below in authorization of them to seek emergency medical or surgical care for your child. Thank you for your cooperation.

Emergency Contact Information

Parental Acknowledgement: If the Program is unable to reach any of the individuals named above promptly by phone, I/we authorize the Program to seek and secure any emergency medical or surgical care for my/our child. I/We will be responsible for all expenses incurred and authorize the medical facility at which treatment is rendered all necessary information to my/our insurance company.
Emergency Contact Name:*

First NameLast NameSuffix
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Emergency Contact Name:*

First NameLast NameSuffix
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number

Section 11: Authorization to Receive Text Messages

This section should be completed by the applicant's parent/guardian.
I agree to receive SMS texts and/or GroupMe messages related to program information and/or activities.*

YesNo
Applicant's Cell Phone Number:*

Area CodePhone Number
Parent/Guardian Cell Phone Number: *

Area CodePhone Number
Please Note: By selecting "No" we will be unable to text you about program and/or activity changes.
I give permission for my daughter to receive SMS texts and/or GroupMe messages related to program information and/or activities.*

YesNo
Please Note: By selecting "No" we will be unable to text you about program and/or activity changes.

Section 12: Confidentiality Agreement
CONFIDENTIALITY POLICY

It is the policy of the San Fernando Valley Alumnae Chapter of Delta Sigma Theta Sorority, Incorporated (“Delta”) to protect the confidentiality of its youth participants and their families. Except as provided below, the San Fernando Valley Alumnae Chapter will only share information about participants and their families with other Delta chapter members and Delta employees assigned to assist with youth initiative programs, on a “need to know basis.” To carry out the mission of its Crowned and Rooted in the Valley Cotillion and Beautillion (CRVCB) program and to better serve the needs of the youth participants, the San Fernando Valley Alumnae Chapter must collect certain personal information about youth participants and their families, including, but not limited to, the following “Confidential Information”:

Name, address, and age of participant
School participant attends
Names and addresses of parents or guardian
Medications and physical conditions/limitations
Any distinguishing marks or characteristics (such as disfigurement physical limitations)

Limits of Confidentiality: Confidential information may be shared with individuals or organizations as specified below under the following conditions, and provided that the party to who seeks any disclosure agrees in writing to maintain the confidentiality of the disclosed information as specified in this Confidentiality Policy:

Delta Officers and Members of the Board have access to any participant’s files only upon directive by the

National President. Any directive shall identify the person(s) authorized to review such records; the specific purpose for such review; and the period of time during which access shall be granted. Such Officers or Members of the Board granted access shall be required to comply with this Confidentiality Policy and may use the information only for purposes specified in the National President’s directive.

Information may only be provided to law enforcement officials or the courts pursuant to a valid and enforceable subpoena or court order.

Information may be provided to Delta’s legal counsel in the event of litigation or potential litigation involving Delta and/or the Program participants or any aspect of the Program.

Members of the San Fernando Valley Alumnae Chapter and volunteers who observe or suspect child abuse are

“mandatory reporters” and, as and, as such, must disclose suspected abuse to the proper authorities, and in making such reports, may disclose “Confidential Information.”

Safekeeping of Confidential Records: The President of the San Fernando Valley Alumnae Chapter or her designee shall be the custodian of confidential records. It is her responsibility to supervise the management of Confidential Information in order to ensure safekeeping, accuracy, accountability, and compliance with this Confidentiality Policy.

Requests for Confidential Information by Other Agencies: Any request from other organizations or persons for Confidential Information shall be honored only if the request is accompanied by written authorization from the parents or guardians of the youth participant expressly permitting the release of the requested information.

Violations of Confidentiality: Known violations of this Confidentiality Policy (by volunteers or youth participants) shall be reported to the chapter president or her designee. A violation of this Confidentiality Policy shall result in disciplinary action up to and including suspension or termination from the Program, as appropriate.

No Liability. There shall be no liability to Delta, the San Fernando Valley Alumnae Chapter, or any volunteer or youth participant for disclosing information that is required to be disclosed by a court, an administrative body of competent jurisdiction, a governmental agency, or by operation of law.
PHOTOGRAPH AND VIDEO AUTHORIZATION AND RELEASE FORM

I/We,{parentlegalGuardians54} (“Parent/Guardian”), as parent(s) or legal guardian(s) of {applicantName}, give permission for San Fernando Valley 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 Crowned and Rooted Cotillion and Beautillion Program from 9/21/25-5/1/26 (date of program year), 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 Crowned and Rooted Cotillion and Beautillion 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 {applicantName} and do hereby give my/our consent without reservation to the foregoing on behalf of my/our child.
Parent/Guardian Signature*

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Section 13: Upload Required Files
Applicant’s Photo *

Upload Applicant’s Photo
Please upload a current headshot photo: (Head and shoulders only - No filters and no selfies) Cancelof
Should be Empty:

Section 1: Applicant Information

Section 2: Applicant Questions

Section 3: Video and Report Card Submissions

Section 4: Escort Questions

Section 5: Parent Information

Section 6: Consent & Authorization Forms

Parent/Guardian Statement of Consent

Crowned and Rooted in the Valley Cotillion & Beautillion Participant Sign In/Sign Out Consent

Section 7: Consent & Authorizations

Section 8: Code of Conduct

PARTICIPATING IN YOUTH INITIATIVES PROGRAM

With my parent or other adult, I have read the Code of Conduct and sanctions for violating the Code. I understand the Code and the sanctions. I will follow the Code of Conduct.

Section 9: Participant Agreements

Virtual Meeting/Event Participant Agreement

Section 10: Medical and Emergency Contact Information

Participant's Health and Medical Emergency Information/Authorization

Emergency Contact Information

Section 11: Authorization to Receive Text Messages

Section 13: Upload Required Files