2025 PGCAC HBCU TOUR APPLICATION

PGCAC SPRING 2026 HBCU Tour Application

Prince George's County Alumnae Chapter, Delta Sigma Theta Sorority, Inc. in Partnership with Delta Foundation, Inc.

Countdown to the 2026 Spring Tour at

Pennsylvania Historically Black Colleges and Universities (HBCUs)

Calling High School Students

Friday, April 10, 2026

7:00 AM - 6:00 PM

Bus departs from Kettering Plaza in Largo, Maryland

(Parking Lot Closest to Ledo’s Pizza and Starbucks)

Observe Campus Life First-Hand at:

Cheyney University | Lincoln University
- Luxury Round-Trip Bus Transportation
- Continental Breakfast, Lunch on Campus and Snacks
- Guided Tours of Both Campuses
Completed Application & Payment of $78.22* Due with Registration

*Online PayPal payments only.
$75 per student + $3.22 PayPal fees makes the cost $78.22

Registration Deadline: Saturday, March 14, 2026 at 11:59PM

NOTE: Payment includes 1 day of tours to both college campuses

For additional information, email HBCU@pgcacdst.org

*YOU WILL NOT BE ABLE TO SAVE THE FORM AND RETURN TO IT LATER. PLEASE HAVE THE FOLLOWING HANDY TO COMPLETE THE MULTI-PAGE FORM:
1. PHYSICIAN'S NAME, ADDRESS AND PHONE NUMBER;
2. EMERGENCY CONTACTS NAMES, ADDRESSES AND PHONE NUMBERS
3. ELECTRONIC PAYMENT FOR PAYPAL
Estimated time to complete is 20 minutes. Signatures are required of both parent and student. You will have an opportunity to review your information and you will receive your completed form via e-mail to the Parent/Guardian e-mail address.

For the safety and well-being of all, COVID protocols are administered.

PART 1 STUDENT CONTACT INFORMATION

REGISTRATION - PARENTAL CONSENT FORM
STUDENT NAME*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
GENDER*

MaleFemaleOther
DATE OF BIRTH*

MonthDayYear
Date
CELL PHONE #*
Please enter a valid phone number.
EMAIL ADDRESS*
example@example.com
CURRENT SCHOOL:*
CURRENT GRADE*
PARENT/GUARDIAN NAME*

First NameLast Name
PARENT/GUARDIAN CELL PHONE #:*
Please enter a valid phone number.
PARENT/GUARDIAN HOME PHONE #:
Please enter a valid phone number.
PARENT/GUARDIAN WORK PHONE #:
Please enter a valid phone number.
PARENT/GUARDIAN EMAIL ADDRESS:*
example@example.com

PART II - STUDENT AGREEMENT
As a condition of my participation in the 2026 Pennsylvania HBCUs Tour, I agree to abide by the Rules of Conduct and adhere to the guidance/directions of the Tour Coordinators/Chaperones.
STUDENT NAME*
STUDENT'S SIGNATURE*
Date*

MonthDayYear
Date

PART III - PARENTAL/GUARDIAN AFFIRMATION WAIVER AND RELEASE
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.
PARENT/GUARDIAN SIGNATURE*
RELATIONSHIP TO PARTICIPANT*
Date*

MonthDayYear
Date

PART IV - 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 other types 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 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 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.
Signature*
Date*

MonthDayYear
Date

PART V - YOUTH PICK-UP AUTHORIZATION
I, PARENT/GUARDIAN* authorize the persons listed below to pick‐up STUDENT* 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).
NAME*
RELATIONSHIP*
HOME PHONE*
Please enter a valid phone number.
CELL PHONE*
Please enter a valid phone number.
WORK PHONE*
Please enter a valid phone number.
NAME
RELATIONSHIP
HOME PHONE
Please enter a valid phone number.
CELL PHONE
Please enter a valid phone number.
WORK PHONE
Please enter a valid phone number.
NAME
RELATIONSHIP
HOME PHONE
Please enter a valid phone number.
CELL PHONE
Please enter a valid phone number.
WORK PHONE
Please enter a valid phone number.
NAME
RELATIONSHIP
HOME PHONE
Please enter a valid phone number.
CELL PHONE
Please enter a valid phone number.
WORK PHONE
Please enter a valid phone number.
NAME
RELATIONSHIP
HOME PHONE
Please enter a valid phone number.
CELL PHONE
Please enter a valid phone number.
WORK PHONE
Please enter a valid phone number.
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 to notify the Chapter in writing of any changes to the above list of authorized persons.
Signature*
Date*

MonthDayYear
Date

PART VI - PARENT WAIVER AND PERMISSION TO TRANSPORT YOUTH
I, PARENT/GUARDIAN* 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 that 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 an adult, 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, I, for myself, my child, my executors, and assigns, further agree to release and forever discharge Delta Sigma Theta Sorority, Incorporated and the Chapter and Delta Foundation, Incorporated 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 application package including all waiver and permission forms, fully understand it, and agree to be legally bound by its terms.
PARENT SIGNATURE*
Date*

MonthDayYear
Date

PART VII - OFF-SITE PERMISSION
I, PARENT/GUARDIAN* as parent or legal guardian give permission for STUDENT* 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.
Signature*
Date*

MonthDayYear
Date

PART VIII - MEDICAL AND EMERGENCY CONTACT INFORMATION
MINOR NAME:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
DATE OF BIRTH:*

MonthDayYear
Date
PHYSICIAN NAME:*

First NameLast Name
PHYSICIAN ADDRESS:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PHYSICIAN PHONE NUMBER:*
Please enter a valid phone number.

Emergency Contacts
EMERGENCY CONTACT #1*

First NameLast Name
EMERGENCY CONTACT #1 ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMERGENCY CONTACT #1 CELL #*
Please enter a valid phone number.
EMERGENCY CONTACT #1 HOME #:*
Please enter a valid phone number.
If for any reason I/we cannot be reached, please contact the following person(s) whom I/we hereby authorize to seek emergency medical or surgical care for my/our child.
EMERGENCY CONTACT #2*

First NameLast Name
EMERGENCY CONTACT #2 ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMERGENCY CONTACT #2 CELL #*
Please enter a valid phone number.
EMERGENCY CONTACT #2 HOME #:*
Please enter a valid phone number.
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.
PARENT/GUARDIAN SIGNATURE #1*
Date*

MonthDayYear
Date
PARENT/GUARDIAN SIGNATURE #2
Date

MonthDayYear
Date

PART IX - RULES OF CONDUCT - INFORMATION SHEET
Parents and/or guardians must review this information in detail with their students to insure a safe, informative, and enjoyable trip for all participants. The form must be signed and returned as a condition of student participation.
ARRIVAL
1. The check-in time for all participants will be communicated during the required HBCU Bus Tour Orientation for students and parents scheduled as a virtual session for Wednesday, March 25, 2026 at 7:00pm.
2. Covid protocols will be administered each day prior to departure.
  Covid protocols will include:
  a. Temperature Checks prior to boarding bus
  b. Masks recommended and will be provided
  c. Hand Sanitizers will be provided
  d. Disinfecting Wipes will be provided
  e. Food handling, on bus, to maximize recipient only contact
3. The motorcoach will depart from the Kettering Plaza Shopping Center at Campus Way South in Upper Marlboro, Maryland (off Central Ave/214). The bus must depart promptly. The bus will return to the Kettering Plaza Shopping Center on the same day at approximately 6:00 PM. Parents/guardians are required to arrive at least 15 minutes before the appointed time to pick up their returning participant(s).
ADVANCE PREPARATION FOR THE TOUR
1. Transportation, continental breakfast, lunch, water, and bus snacks are included in the cost of the trip. Students are responsible for any other food desires or necessities. It is expected that all students will bring additional money to pay for any souvenirs and other incidentals that they choose to purchase.
2. Students may bring a purse and/or backpack if they choose to do so and will be personally responsible for it without adult assistance.
3. All students must bring a photo ID and medical card to carry with them during the tours. Students should also bring a copy of photo ID and insurance card to turn in at check in. Copies will be returned to students at the end of the day. NOTE: Chaperones will not administer any prescription or over-the-counter medications.
4. All parents and students must read and sign the parental agreement to confirm their understanding and acceptance of the rules as noted on the required documents.
EXPECTATIONS ON THE BUS
1. All passengers must remain seated at all times while the motor coach is moving.
2. All passengers are expected to keep the floor area in front and around their seats free of any articles. All articles must be stored in overhead compartments.
3. Eating and drinking will be allowed as long as trash is properly disposed. These privileges may be revoked at any time by the driver, if trash is not properly disposed. Trash bags will be provided.
4. All passengers are expected to make sure that the motor coach is clean at all times and that all trash and personal items are removed prior to exiting the bus.
5. The following food items will not be allowed on the coaches: sunflower seeds, ice cream, chewing gum, funnel cake, and cups without lids.
6. All passengers will be responsible for any items of value such as computers, video games, cameras, cash, clothing, and audio equipment. If these items are damaged or stolen, Prince George’s County Alumnae Chapter of Delta Sigma Theta Sorority, Inc. will not be responsible.
7. All audio devices must have headsets, if being played on the motorcoach.
8. Students will not be allowed on the motorcoach without the presence of an adult chaperone.
9. All passengers will be responsible for any damages to the motor coaches including broken seats, windows, damaged armrests, and food stains on seats and floors.
10. All passengers are expected to be respectful to the driver and other passengers at all times. Profanity will not be tolerated.
11. Motor coaches will be equipped with DVD/CD players. All items to be played must be given to the chaperones on the motor coach for approval. Drivers will only play items given to them by the chaperones. Movies rated R and CDs with Parental Advisories will not be played on the motor coaches.
EXPECTATIONS DURING THE TOUR
1. Students are expected to be fully engaged when in sessions with the Admission Officers. Sleeping, head down on the desk, and carrying on individual conversations while others are presenting information are unacceptable behaviors. Students are encouraged to take notes and collect the informational brochures given by the Colleges/Universities. This effort will afford students and parents with opportunities to review and discuss suitable college and/or career choices upon returning home.
2. The Sorority will not be responsible for lost or stolen items. Cell phones, tablets, and other valuables may be brought along at the student’s own risk. If a student brings audio equipment, s/he must use headphones.
3. Full and appropriate dress is mandatory at all times during the tour. The dress code is comfortable, clean, neat, and tasteful attire. Students should wear comfortable walking shoes and bring an umbrella and rain gear in case of inclement weather. Jeans/casual pants should be worn with a belt. Pajamas, fleece pants, and robes cannot be worn on the tour. Shorts, obscene/offensive T-shirts, midriff tops or tops that expose the belly button, micro mini-dresses/skirts, and sheer blouses are considered inappropriate attire.
4. During all on-campus visits, cell phones must be turned OFF. No text messaging or receipt of calls will be allowed during this time. Parents and guardians should direct all urgent calls to the emergency local contacts provided by the Sorority on the morning of departure. These local committee members will contact the chaperones on the tour, as needed.
5. Students are expected to stay with the group at all times and, for safety and accountability reasons, will not be permitted to leave the group under any circumstances. With advance notice from parents during check-in, friends and/or family may visit students during our lunch stop or may join the group during the walking tour.
6. There will be no provision to send funds to students while on the tour (i.e., Western Union, Federal Express, Express Mail, or in any other form).
OUR SIGNATURES indicate that we (the parent/guardian and the student) have read and understand the Rules of Conduct and agree to abide by these directives as a condition of student participation in the HBCU Tour.

PRINTED NAME OF THE STUDENT:*
SIGNATURE OF THE STUDENT*
Date*

MonthDayYear
Date
PRINTED NAME OF THE PARENT:*
SIGNATURE OF THE PARENT*
Date*

MonthDayYear
Date

PART X - HBCU TOUR: DISCIPLINARY CONSENT FORM

STUDENT/PARENTAL DISCIPLINARY AGREEMENT
STUDENT NAME*

First NameLast Name
PARENT NAME*

First NameLast Name
PARENT NAME

First NameLast Name
I/We, the parent(s)/guardian(s) of the student named above, understand and agree that the following conditions will apply to the HBCU Tour:
- My/Our child is expected to behave responsibly and abide by the rules of conduct at all times during the HBCU Tour. Further, my/our child will follow the guidance and directions of the Tour Chaperones.
- The following acts are strictly prohibited on the tour: Illegal Drug or Alcohol use; Smoking; Theft; Possession of Weapons; Gambling; Profanity; and Violations of Established Dress Code. This list is not exhaustive. The Tour Chaperones reserve the right to prohibit my child from committing other acts they deem inappropriate.
- The actions of my child are my/our responsibility, and I/we release the Delta Foundation, Inc, and the Prince George’s County Alumnae Chapter of Delta Sigma Theta Sorority, Inc., its members, and any of the Tour Chaperones from any and all claims, liabilities, or damages incurred as a result of my/our child’s behavior.
- 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
  
  -Next occurrence youth is separated, partnered with chaperone.
  
  Physical Violence and Other Misconduct:
  
  - 1st Time: Removal from situation, loss of privileges, parent or guardian notified from this point forward
  
  - Next occurrence youth is separated, partnered with chaperone.
  
  Illegal Substances or Dangerous Weapons:
  
  -1st Time: Youth is separated, and partnered with a chaperone. If a youth is in possession of an illegal substance or dangerous weapon, the police will be notified as well.
- I/We understand that if my/our child is removed from the HBCU Tour due to misconduct, none of the tour cost will be refunded.
- I/We agree to the terms above and give my/our permission for my/our child to participate in the HBCU Tour sponsored by the Prince George’s County Alumnae Chapter of Delta Sigma Theta Sorority, Inc. in partnership with the Delta Foundation, Inc.
PARENT/GUARDIAN SIGNATURE*
Date*

MonthDayYear
Date
STUDENT DECLARATION: I have read this agreement, and I understand that I am to act on this tour in the same responsible manner in which I am expected to conduct myself in school. I understand that if I commit any acts of serious misconduct, I will be subject to immediate dismissal from the tour at the expense of my parent(s)/guardian(s).
STUDENT SIGNATURE*
Date*

MonthDayYear
Date

Participant and Parent Guardian Acknowledgements
Participant Acknowledgement (Student Participant)

With my parent/guardian, I have fully read and understand the Participant Agreement. I acknowledge that should I fail to abide to the Code of Conduct that my actions will be subject to disciplinary action as defined. I hereby acknowledge, understand, and agree to comply with the terms set forth in the Participant Agreement.
STUDENT NAME*

First NameLast Name
Signature*
Date*

MonthDayYear
Date
Parent/Guardian Acknowledgment

I have fully read and understand the Participant 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 Participant Agreement.
PARENT/GUARDIAN NAME*

First NameLast Name
PARENT/GUARDIAN SIGNATURE*
Date*

MonthDayYear
Date

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PGCAC SPRING 2026 HBCU Tour Application

PART 1 STUDENT CONTACT INFORMATION

PART II - STUDENT AGREEMENT

PART III - PARENTAL/GUARDIAN AFFIRMATION WAIVER AND RELEASE

PART IV - PHOTOGRAPH, MEDIA AND VIDEO AUTHORIZATION RELEASE FORM

PART V - YOUTH PICK-UP AUTHORIZATION

PART VI - PARENT WAIVER AND PERMISSION TO TRANSPORT YOUTH

PART VII - OFF-SITE PERMISSION

PART VIII - MEDICAL AND EMERGENCY CONTACT INFORMATION

HEALTH INFORMATION

Emergency Contacts

PART IX - RULES OF CONDUCT - INFORMATION SHEET

ARRIVAL

PART X - HBCU TOUR: DISCIPLINARY CONSENT FORM

Participant and Parent Guardian Acknowledgements

Payment