BSA/GEMS Application - Program Year 2025 Logo
  • BSA/GEMS Application - Program Year 2025

    Both parent and participant are encouraged to review and complete this application together.
  • Anticipate 30 minutes to review and submit the necessary paperwork contained in the application.

    Make certain the email address you supply for the parent and participant are accurate. Communication is through email.

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    Message from Madame President

    Greetings!

    The Jacksonville (FL) Alumnae Chapter of Delta Sigma Theta Sorority, Inc., is excited that you and your youth are interested in joining the Dr. Betty Shabazz Academy ("Delta Academy") and the Dr. Jeanne L. Noble GEMS Institute ("Delta GEMS"). We are committed to providing a wonderful and worthwhile experience for you!

    PLEASE REVIEW, COMPLETE, AND SUBMIT THIS ENROLLMENT AND PARENTAL CONSENT FORM BY NO LATER THAN SEPTEMBER 8, 2025.

    Applications are accepted on a first come first-serve basis. Due to the nature of our program space is limited so we encourage you to apply early. If your youth is selected, both parent or guardian and young lady - will be invited to attend the BSA/GEMS Kick-Off Event that will provide an overview of this year's program.

    Kick-Off Event details will be sent to those accepted into the program via the email address provided. Please make certain your information is correct. Carefully review the included information.

    If you have any questions, feel free to email the program committee chairs Nancy Grant and Aniah Jackson at dstjaxbsagems@gmail.com. We are excited about this program year and look forward to working with you and your daughters.

     

    Sincerely,

    Christina Stallings, President

    Jacksonville (FL) Alumnae Chapter Delta Sigma Theta Sorority, Inc.

  • About The Program

    The Dr. Shabazz Delta Academy and the Dr. Jeanne L. Noble Delta GEMS (Growing and Empowering Myself Successfully) Institute are two educational programs initiated by Delta Sigma Theta Sorority, Inc., in an effort to prepare young women for leadership in the 21st century and to promote the principles of scholarship, service, and sisterhood.

    The Delta Academy program was created out of an urgent sense that bold action was needed to save our young females (ages 11-14) from the perils of academic failure, low self-esteem, and crippled futures. Additionally, as a natural outgrowth and expansion of the Delta Academy, the Delta GEMS Institute was created to address at-risk, adolescent girls (ages 14-18). Both programs are designed to enrich and enhance the education already provided by the various school systems.

    The Delta Academy and Delta GEMS programs are free to participants. In keeping with Delta Sigma Theta's national program objectives, the Jacksonville (FL) Alumnae Chapter incorporates program offerings in math, science, technology, and reading. In addition, participants take part in workshops on self-esteem building, manners/etiquette, and health and nutrition.

    Program offerings include a variety of experiences and interactives to promote women and girls' empowerment, service-learning, and personal development. While each program's curriculum is designed for the specified age groups, there will be many activities that will be attended by both groups concurrently. This enhances each girl's experience and allows her to have exposure to activities that are worthwhile to her development.

    Members of both programs learn through active participation in organized service-related projects and activities. These fulfilling service activities meet community needs while equipping participants with the tools to help them cultivate and maintain interpersonal relationships in all areas of life. Program days generally occur once a month, however, participants may occasionally meet more frequently for specially scheduled activities.

    PROGRAM STANDARDS: To ensure and maintain a high quality participant experience at program days and special events, Delta Academy and Delta GEMS participants are asked to follow the standards listed below.

    • Prompt and regular attendance. Three consecutive absences (excused or unexcused) are treated as voluntary withdrawal.

    • A participant MUST contact a co-chair at least 24 hours in advance of the scheduled meeting or activity to quality for an excused absence.

    • Prompt and obedient responses to directions from committee members, members of Delta Sigma Theta, program day presenters, and peer leaders.

    • Appropriate personal conduct in all program days, workshops, and sessions.

    • Appropriate program (fun business casual) attire or otherwise if specified for program days.

    • Fair and respectful treatment of fellow Delta Academy, Delta GEMS participants, and all volunteers.

    • Strict compliance with guidelines for field trips and the college tours.PROGRAM SUPPORTThe Dr. Betty Shabazz Delta Academy/Dr. Jeanne L. Noble Delta GEMS Institute (BSA/GEMS) committee is charged with the primary responsibility for the programs.

    The committee is supported by the membership of the Jacksonville (FL) Alumnae Chapter of Delta Sigma Theta Sorority, Inc. Program day presenters may be from various parts of the community (i.e., various professions, technical fields, faith-based, etc.) to ensure participants have rich and meaningful experiences.

    Parents and Guardians are key to the achievement of the program objectives. You are strongly encouraged to promote the success of the program by:

    • Ensuring your youth has prompt and regular attendance.

    • Ensuring your youth has transportation to and from ALL program activities.

    • Regularly checking and responding to emails. All program notifications are communicated via email as it is listed in the application.

    • Providing materials your youth needs for projects and special events. Details are communicated well in advance at program days and via email.

    • Performing other various tasks as agreed upon with the committee members.

  • Participant Information

    This section's information should be for the participant.
  •  - -
  • Participated in BSA/GEMS before

  • Parent or Guardian Section

    This information is about the parent/guardian.
  • APPENDIX B1:  PARENTAL/GUARDIAN AFFIRMATION 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
    Chapter’s 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.

    As the Parent/Guardian, I hereby give my permission for my child to participate in the Chapter’s youth initiative (including planned activities), and I hereby attest, under penalty of perjury, that I have the legal authority to authorize such participation.

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  • APPENDIX B2: PHOTOGRAPH, MEDIA, AND VIDEO AUTHORIZATION RELEASE FORM

    I, ___________________________________________, Parent/Guardian, on behalf of
    ____________________________________________ (“Participant Minor Child”) give permission for the local 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 Youth Initiative Program activities, without payment or any consideration and without notifying me in advance.
    I 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 othertypes
    of media without payment or any consideration and without notifying me.

    I 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 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 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 ofsaid 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 hereby certify that I am the Parent/Guardian, and I am authorized legally to give this consent, and do hereby give my consent without reservation to the foregoing on behalf of my child.

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  • APPENDIX B3: YOUTH CODE OF CONDUCT FOR IN‐PERSON MEETINGS

    PARTICIPANT NAME: ____________________________________________________

    1. 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.
    2. 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.
    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 a 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.

    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
    1set 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.

     

    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 required below.

    Parent Signature required below.

    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 Chapter’s youth
    program. I agree that the sanctions for violating the Code of Conduct are reasonable and will help my child
    comply.

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  • APPENDIX B4: YOUTH PICK‐UP AUTHORIZATION

    I, _______________________________________ authorize the persons listed below to pick‐up
    _________________________________________ from the youth initiatives 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. (Please include parents/guardians
    names).

    List names in the spaces provided in the next question.

    By signing below, I verify that I have read and agree to the Student Pick‐Up policies described above and authorize the Chapter to release my child to the persons listed above. I also agree tonotify the Chapter in writing of any changes to the above list of authorized persons.

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  • APPENDIX B6a

    PARENT WAIVER AND PERMISSION FOR YOUTH TO BE TRANSPORTED BY TEENAGE DRIVER

    ALL TEENAGE DRIVERS MUST HAVE A NON‐PROVISIONAL DRIVER’S LICENSE

    List the Name of Child participant, Event, Location, and the Teenage Driver in the space below.


    (Note: If giving permission for driver to transport youth to all activities, please indicate “ALL” for Event & Location)
    I give permission for my child (“child”) to be transported in a motor vehicle driven by the individual identified
    to an event at the specified location on the date indicated. I understand my child is expected to follow all
    applicable laws regarding riding in a motor vehicle and is expected to follow the directions provided by the
    driver.
    I have read, understand, and discussed with my child that:
    1) They will be traveling in a vehicle driven by a teenage driver, and they are to wear their safety belt while traveling.
    2) They are expected to respect the vehicles they ride in and the person they travel with during the trip.
    3) Riding in a motor vehicle may result in personal injuries or death from wrecks, collisions, or acts by riders, other drivers, or objects; and
    4) They are to remain in their seats and not be disruptive to the driver of the vehicle.


    I recognize that by participating in this activity, as with any activity involving motor vehicle transportation, my child may risk personal injury or permanent loss.

    I hereby attest and verify that I have been advised of the potential risks, that I have full knowledge of the risks involved in this activity, and that I assume any expenses that may be incurred in the event of an accident, illness, or other incapacity, regardless of whether I have authorized such expenses.


    As a condition for the transportation received/provided, I, for myself, my child, my executors, and assigns, further agree to release and forever discharge Delta Sigma Theta Sorority, Incorporated and the Chapter from any claim that I might have myself or that I could bring on my child’s behalf with regard to any damages,
    demands or actions whatsoever, including those based on negligence, in any manner arising out of this transportation. I have read this entire waiver and permission form, fully understand it, and agree to be legally bound by its terms.


    Required Signatures:

    Participant Parent/Guardian Signature

    Teenage Driver Parent/Guardian Signature

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  • APPENDIX B6b

    PARENT WAIVER AND PERMISSION FOR TEENAGE DRIVER TO TRANSPORT YOUTH
    ALL TEENAGE DRIVERS MUST HAVE A NON‐PROVISIONAL DRIVER’S LICENSE

    ALL TEENAGE DRIVERS MUST HAVE A NON‐PROVISIONAL DRIVER’S LICENSE

    List the Name of Child participant, Event, Location, and the Teenage Driver in the space below.


    (Note: If giving permission for the driver to transport youth to all activities, please indicate “ALL” for Event & Location)
    I give permission for my child (“child”) to transport the individual identified above in a motor vehicle to the event at the specified location. I understand my child is expected to follow all applicable laws regarding driving a motor vehicle and is expected to follow the directions provided by all motor vehicle laws.


    I have read, understand, and discussed with my child that:
    1) They will be driving a vehicle with other youth participants, and they are to wear their safety belt while traveling.
    2) They are expected to respect the vehicles they ride in and the person they travel with during the trip.
    3) Riding in a motor vehicle may resultin personal injuries or death from wrecks, collisions, or acts by riders, other drivers, or objects. 


    I recognize that by participating in this activity, as with any activity involving motor vehicle transportation, my child may risk personal injury or permanent loss.

    I hereby attest and verify that I have been advised of the potential risks, that

    I have full knowledge of the risks involved in this activity, and that I assume any expenses that may be incurred in the event of an accident, illness, or other incapacity, regardless of whether I have authorized such expenses.

    As a condition for the transportation received, I, for myself, my child, my executors, and assigns, further agree to release and forever discharge Delta Sigma Theta Sorority, Incorporated and the Chapter from any claim that I might have myself or that I could bring on my child’s behalf with regard to any damages, demands or actions whatsoever, including those based on negligence, in any manner arising out of this transportation.

    I have read this entire waiver and permission form, fully understand it, and agree to be legally bound by its terms.

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  • APPENDIX B7: OFF‐SITE PERMISSION

    I, as parent or legal guardian give permission for my daughter to participate in the Chapter’s Youth Initiatives Program’s (the “Initiatives”) activities taking place off site. I understand that transportation to and from these activities will be
    provided for my Child by the Chapter.

    I understand that the field trips are part of the Initiatives and if I choose to not have my Child participate in
    one or more off‐site activities, I must make other care arrangements for my/our child during the times of that
    field trip activity.

    I 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 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.

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  • APPENDIX B8: MEDICAL AND EMERGENCY CONTACT INFORMATION

     

    This file will be emailed to you to complete and return via email.

  • APPENDIX B11: CONFIDENTIALITY POLICY

    It is the policy of the local Chapter of Delta Sigma Theta Sorority, Incorporated (the “Chapter”) to protect the confidentiality of its youth participants and their families. Except as provided below, the 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 youth program and to better serve needs of the youth participants, the Chapter must collect certain personal information about youth participants and their families, including, but not limited to, the following “Confidential Information”:
     Name and address of participant AND parents or guardian
     Participant age and school
     Medical conditions / physical limitations
     Any distinguishing marks or characteristics (such as tattoos or birthmarks)
    Limits of Confidentiality: Confidential information may be shared with individuals or organizations as specified below under the following conditions, and provided that the party 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 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 Chapter and volunteers who observe or suspect child abuse are “mandatory reporters” 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 Chapter or her designee shall be the custodian of confidential records. It is her responsibility to supervise the management of Confidential Information 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 the 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.

  • APPENDIX B12: YOUTH SIGN‐IN/SIGN‐OUT POLICY

    It is the policy of the local Chapter of Delta Sigma Theta Sorority, Incorporated (the “Chapter") that all youth participants, members, other volunteers, and visitors must sign in and out of its Youth Initiative Program (“Program”).
    The required sign‐in/sign‐out procedures are as follows:
    • The Chapter shall maintain and use a sign‐in log that reflects the following: name of the youth initiative; the date; the time in and the time out; and the names of the
    participants, with a column for the participant and visitors to check her/their status (as member, youth, volunteer, or visitor). The form should distinguish whether a member is assisting with the Program or is a visitor/observer.


    • Only authorized persons (those identified in writing) will be allowed to pick up a
    participant from the Program. Volunteers shall refuse to release a participant to any
    person, whether related or unrelated to the youth, who has not been authorized, in
    writing, by the parent or guardian to receive the youth.


    One of the following procedures shall be observed during departure and return:
    a. Parents or an authorized representative will sign out youth.


    b. Older youth who have written Parental permission will be allowed to leave the program on their own. Members will establish a system where the youth check themselves out with an approved volunteer; the approved volunteer will ensure that the youth signed out and initialed the attendance sheet.


    c. When Chapters provide transportation to off‐site sponsored events, members will develop and implement a system to ensure that all youth participating for the day board the correct bus or other vehicle at the time of departure to and return from a scheduled activity. Failure to pick up your child at the conclusion of a session or activity will result in contact being made with the local police department and/or child protective services.


    If a Parent or Guardian wishes to arrange alternative transportation for their child to attend an off‐site activity, the youth may join the group at the event or activity, but the Chapter assumes no responsibility or liability for the youth participant for any non‐Chapter‐sponsored activity or transportation.

  • APPENDIX B13: INTERNET YOUTH POLICY

    1. Purpose
    This policy relates to the use of computers or Internet access through, during, or as part of any Delta Sigma Theta Sorority, Incorporated (“Delta”) Youth Initiative Program (“Program”) or sponsored event.
    The purpose of the policy is to protect the participating youth from gaining access to undesirable materials on the Internet; from making undesirable contacts over the Internet; and to prevent unacceptable use of the Internet by youth participants, including, but not limited to, using the Internet for cyber‐ bullying. The focus of the policy is on both personal and shared responsibility.


    2. Definitions and Illustrative Examples
    A. Examples of Prohibited Materials
     Pornographic images or obscene images or text on Internet websites.
     Material that contains abusive, profane, inflammatory, coercive, defamatory, blasphemous, or otherwise offensive language on websites or in e‐mail messages.
     Racist, exploitative, or illegal material or messages on websites or in e‐mail.


    B. Examples of Prohibited Contacts
     Responding to e‐mail messages or solicitations (through advertisements or web postings) from unknown or unverified parties who seek to establish a youth’s identity and/or to communicate with the youth for any purpose.


     Initiating contact with unknown or unverified parties or parties seeking to contact youth for any purposes.


    C. Examples of Prohibited Contacts
     Deliberately searching for and accessing prohibited materials.
     Creating and transmitting e‐mail messages that contain unacceptable language or content, such as that listed above in 2A, bullet 2; and
     Creating and publishing Internet materials that contain unacceptable language and content.


    D. Examples of Cyber‐bulling
    Cyber‐bullying includes, but is not limited to, the following misuses of technology: harassing, teasing, intimidating, threatening, or terrorizing another individual by way of any technological tool, such as sending or posting inappropriate or derogatory email messages, instant messages, text messages,
    digital pictures or images, or website postings which has the effect of:
     Physically, emotionally, or mentally harming an individual.
     Placing an individual in reasonable fear of physical, emotional, or mental harm.
     Placing an individual in reasonable fear of damage to or loss of personal property; or
     Creating an intimidating or hostile environment that substantially interferes with an individual’s educational opportunities.

     

    3. Unintentional Exposure of Youth to Prohibited Materials on the Internet
    It is Delta’s policy that Chapters must undertake every reasonable step to prevent exposure of youth participants to undesirable materials on the Internet. It is recognized that this can happen not only through the youth deliberately searching for such materials, but also unintentionally when a justifiable
    Internet search yields unexpected results.

    To prevent such occurrences the Chapter shall adopt the following practices:
    A. Chapters should use an Internet Provider or software that blocks access by:
    • Filtering sites by a grading process, and
    • Filtering sites by language content and prohibit sites with unacceptable vocabulary.
    B. Chapters must strictly supervise Internet usage:
    • Adults must strictly supervise youth participant’s Internet activity, and there should be no searching of the Internet without a supervisor checking periodically during use and reviewing the sites accessed after a youth logs off.
    • Install appropriate language filtering software (e.g., Net Nanny).

    4. Intentional Access of Prohibited Materials by Youth
    Chapters shall explain clearly and firmly to the youth that they are prohibited from intentionally accessing prohibited material on the Internet. The youth also must be informed that if she/he violates this policy, she/he will be disciplined, and her/his Parents or Guardian will be notified. Chapters must follow through with disciplining the youth and notifying the Parents or Guardians.
    5. Deliberate Access to Prohibited Materials by Adults: Adults are prohibited from deliberately accessing prohibited materials. Any adult who violates this
    policy will be terminated as a volunteer.
    6. Receipt and transmission of e‐mails by youth
    It is recognized that, even with training and supervision, youth may receive or transmit e‐mail messages that contain unacceptable (or even prohibited) language or content. It is also recognized that some people may try to use e‐mail to identify and contact children for unacceptable reasons.


    To avoid these problems, Chapters should adopt the following practices:
    A. Use an Internet e‐mail service that guarantees the bona‐fide nature of e‐mail communicants and that vets youth’s e‐mail for undesirable content.
    B. Depending on the circumstances and the age or maturity of the youth, allow youth to read e‐mail messages only when an adult is present or when the messages have been previewed by an adult.
    C. Take steps to verify the identity of anyone seeking to establish regular e‐mail communications with youth.
    D. Allow youth to send e‐mail messages only when the contents have been approved by an adult.

    If staff or volunteers believe that youth have been targeted with e‐mail messages by parties with
    criminal or inappropriate intent, immediately take the following steps: retain the messages; record the incident by completing the Risk Management incident Report form; inform the youth’s
    Parents; report the incident to law enforcement or other local or state authorities, and report the incident to the Chapter President and the Regional Director.

    7. Publishing Materials on the Internet
    No materials, whether created by volunteers or youth participants, that contain any prohibited images, language, or content shall be published on the Internet. Infringement of this rule shall result in disciplinary action.
    No materials shall be published on the Internet that reveals the identity of any youth.
    8. Use of Delta’s Internet by Visitors and Guests. No visitor or guest shall be allowed to use any Delta computer.
    9. Intellectual Property Rights
    A. Delta’s Intellectual Property. No individual member owns any of Delta’s intellectual property (which includes any Delta logo, word(s), or phrase(s) commonly associated with, and understood
    to refer to, Delta, and the “look” of any Mark used to distinguish merchandise and service as being associated with or related to Delta. Thus, no member is authorized to use such property for any inappropriate or any commercial purpose (i.e., to make money from using the property or to promote other causes), or to authorize any third party to use Delta’s intellectual property for any purpose. See Delta’s Code of Conduct, Social Media Guidelines, and Primer on the Use of
    the Intellectual Property of Delta.


    B. Third Partiers” Intellectual Property Rights. All materials on the Internet are copyrighted and/or trademarked unless copyright has been expressly waived. Delta respects the intellectual property rights (copyright, trademarks, service marks, and related rights) of third‐party owners Internet materials, and Delta assumes no liability for violations of any intellectual property rights by volunteers or youth participants.

    10. Parental Approval of Publication of Photographs or Other Materials
    Chapters may publish photographs of youth participants on the Internet only if the Parent or Guardian has granted authorization. Depending on the nature and content, other materials may be published so long as the Parent or Guardian has given written consent. Delta must obtain the signed Photograph, Media, and Video Authorization Form from the Parents/Guardians of a youth before publishing any
    content that includes images of a youth participant (Appendix B2).

  • APPENDIX B10: PARENT/GUARDIAN ACKNOWLEDGEMENT OF INFORMATIONAL FORMS

    The Parent/Guardian forms listed below are for informational purposes and do not require a signature.


    Please provide your signature in the boxes below to agree that:

    I acknowledge review of the form and that I have read and understand the information provided.

    Please retain Appendix B10 with the forms that are signed and returned once they are provided to you via email.

     

    B11 Confidentiality Policy                                                                                B12 Youth Sign‐In/Sign‐Out Policy
    B13 Internet Youth Policy

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    • I give permission for this applicant (my child) to attend and participate in the Dr. Betty Shabazz Delta Academy / Dr. Jeanne L. Noble Delta GEMS Institute meetings during the 2025 - 2026 program year.
    • I will ensure that my child has transportation to and from all program days and/or field trips.
    • I will ensure that my child is picked up from all program days and/or field trips on time.
    • I will ensure my child adheres to the program standards listed above.

    Agree by signing the box below

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