• 2026-2027 Delta G.E.M.S. and Academy Application

    The Johnston County Alumnae Chapter’s Delta G.E.M.S. and Delta Academy programs are designed to support, empower, and enhance the development of young women ages 11 to 18 in the Johnston County community. These programs provide participants with opportunities for personal growth, academic enrichment, leadership development, and community service
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Is this your first time participating in Delta G.E.M.S. and Academy?*
  • Parent/Guardian Information

  • Additional Information

  • Parent/Guardian Affirmation

  • I, ______________________________, hereby give my permission to the JOHNSTON COUNTY ALUMNAE CHAPTER of Delta Sigma Theta Sorority, Incorporated for ___________________________________ to participate in the DELTA GEMS / DELTA ACADEMY youth initiative (including planned activities), and I hereby attest, under penalty of perjury, that I have the legal authority to authorize such participation.
  • I have read and agree to the conditions in the Parent/Guardian Affirmation.*
  • Wavier 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 Delta Academy/GEMS 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.
  • I have read and agree to terms in Waiver and Release Statement for my child. *
  • Photograph, Media and Video Authorization Release Form

    I/We, ____________________________________________ (“Parent/Guardian”), as parent(s) or legal guardian(s) of ___________________________________, give permission for Johnston County 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 during participation in Delta Academy /GEMS 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 authorize the Chapter to publish or distribute these Images for the purpose of publicizing the Chapter’s programs, including the Delta Academy/GEMS 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 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 _____________________________,authorized legally to give this consent and do hereby give my/our consent without reservation to the foregoing on behalf of my/our child.
  • I have read and agree to the terms outlined in the Photograph, Media and Video Authorization Release Form. *
  • Youth Code of Conduct

    Respect all participants (other youth 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.+Respect the property rights of others. 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.+Return supplies to their proper place after using them.+Clean up all work areas properly.+Listen carefully to directions and when someone else is talking.+Respect designated quiet areas, such as homework/reading area.+Stay within the program’s designated areas within the building.+Cooperate and participate in organized activities.+Assume full responsibility for all personal belongings.  Please leave valuables at home.+Do not bring any weapons, cigarettes/drugs, alcohol, or anything illegal to any activity at any time. SANCTIONS FOR VIOLATING CODE OF CONDUCT 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-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 . 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. 
  • STUDENT: 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. *
  • PARENT: 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 program. I agree that the sanctions for violating the Code of Conduct are reasonable and will help my child comply. *
  • A Youth Initiative Virtual Meeting/Event Participation Agreement

    I/We, ______________________________________ (“Parent/Guardian”), as parent(s) or legal guardian(s) of _______________________________, give permission for Delta Sigma Theta Sorority, Inc. (“the Sorority”) and the_________________ Chapter of Delta Sigma Theta Sorority, Incorporated (the “Chapter”, together with the Sorority, “Delta”) to host and facilitate closed virtual meetings/events using  Zoom (“the Virtual Meeting Platform”), that my/our child will attend during participation in _______________________ 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 "Participation Agreement").   I/We 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/We will be responsible for reviewing the virtual meeting platform’s privacy terms and conditions before registering for virtual meetings/events.  I/We also understand that my/our 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/We 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/We 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 unintentional.
  • Participant Acknowledgement (Student Participant) With my parent/guardian, I have fully read and understand the Participation Agreement. I acknowledge that should I fail to abide to the Code of Conduct that my actions will be subject disciplinary action as defined. I hereby acknowledge, understand, and agree to comply with the terms set forth in the Participation Agreement. *
  • Parent/Guardian Acknowledgment I have fully read and understand the Participation Agreement. I also understand that my child’s compliance with the Code of Conduct is a condition of her/his participation in the program. I hereby acknowledge, understand, and agree to comply with the terms set forth in the Participation Agreement. *
  • Virtual Meeting and Publicity Code of Conduct

    The Youth Participant Virtual Meeting and Publicity Code of Conduct serves as codified guidance for youth participation in Delta’s Youth Initiative Programs, namely those of a virtual nature. Your signature on the Participation agreement indicates your complete understanding and agreement to comply with this Code of Conduct.   Failure to comply with this Code of Conduct may result in loss of privileges and/or removal from Delta’s Virtual Youth Initiative Programs. As a youth participant in Delta’s Virtual Youth Initiative Programs you are expected to: Refrain from use of any profane, foul, hurtful, obscene or vulgar language in any virtual chatroom and during the virtual meetings and events; Refrain from engaging in any violence, cyber-bullying, or other aggressive behaviors that may threaten the welfare of other participants; Refrain from any disruptive behavior that may disrupt the virtual meetings and events; Be properly groomed and dressed for all virtual youth initiative meetings and events, refrain from wearing articles of clothing that displays profane or obscene language and/or images; Keep your camera on at all times during all virtual youth initiative meetings and events; Provide a noise-free environment while participating in any and all virtual youth initiative meetings and events; Refrain from taking, presenting, and posting any photographs, screen shots, video recordings, and/or screen recordings of any virtual youth initiative meetings or any confidential information disseminated during any virtual youth initiative meetings; Refrain from taking, presenting, and posting any and all inappropriate content including photographs, screen shots, video recordings, and/or screen recordings of any other youth participants of Delta’s youth initiative programs; Contact the leader of your youth initiative program if you have any questions or need clarification regarding the Code of conduct. SANCTIONS FOR VIOLATING CODE OF CONDUCT 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-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   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.  
  • I have read and agree to the conditions outline is the virtual meeting code of conduct. *
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