Delta Academy Participant Registration
2026-2027
The Dr. Betty Shabazz Delta Academy was created in 1996 out of an urgent sense that bold action was needed to save our young females (Middle School: Ages 11-14) from the perils of academic failure, low self-esteem, and crippled futures”. A primary goal of the program is to prepare young girls for full participation as leaders in the 21st Century.
SECTION 1: PARTICIPANT INFORMATION
Thank you for your interest in the Delta Academy program. Please click on this link to complete your registration and payment. Thank you.
Participant Name:
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First Name
Last Name
Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Participant Age (Fall 2026):
*
Participant Email Address:
This will only be used to provide program information and updates.
Participant Date of Birth (M/D/YYYY):
*
Participant Grade Level (Fall 2026):
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Participant School (Fall 2026):
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City/County of:
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Is your mother a member of Delta Sigma Theta Sorority, Inc.?
*
No
Yes
Are You a Returning Participant?
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Yes
No
If Yes, List Previous Years
If Yes, List any previous location(s):
Participant's T-Shirt Size (Select One)
*
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
Please List Any Allergies (If None Write N/A)
*
Participant Three Favorite Items
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Participant Favorite Subject
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Participant Favorite Hobby / Interest
*
SECTION 2: PARENT INFORMATION
Parent/Guardian Name:
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First Name
Last Name
Phone Number (Home):
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Please enter a valid phone number.
Format: (000) 000-0000.
Phone Number (Cell):
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address:
*
Please do not use work email addresses. This will be used to provide program information and updates.
Primary Emergency Contact (if different from above)
*
Primary Emergency Contact Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
SECTION 3: PAYMENT INFORMATION
Payment:
*
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Delta Academy (Middle School Ages 11-14)
Please note, this fee is non-refundable.
$25.00
$
25.00
Quantity
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