My Black is Beautiful

My Black is Beautiful Registration Form

Please complete the form to register for the workshop. If you are registering a group of 6 or more girls, upload a document listing each participant's full name, age, email, school, T-shirt size and dietary restriction if applicable. Registration will close on March 30th or when capacity has been met.
"Hi Beautiful!

Pre-Registraion is now closed.

Don't worry, it's not too late! We will be accepting on-site registration on the day of the event. Please arrive by 8:30AM for onsite registration.

Hope to see you there!"
Group Registration? *

Yes No
Group Name:
Group Contact:

First Name Last Name
Contact E-mail:
Contact Number:

- Area Code Phone Number
Upload Group Form
Would you like to attend the adult sessions?

Yes No
Participant 1:

First Name Last Name
(1) Age:
(1) E-mail:
(1) School:
(1) First time attendee?

Yes No
(1) T-Shirt size?:

S - Youth S - Adult M - Youth M - Adult L - Youth L - Adult XL - Youth XL - Adult
(1) Dietary Restriction?

Yes No
(1) List Restrictions:
Register 2nd Participant?

Yes No
Participants 2:

First Name Last Name
(2) Age:
(2) E-mail:
(2) School:
(2) First time attendee?

Yes No
(2) T-shirt size?:

S - Youth S - Adult M - Youth M - Adult L - Youth L - Adult XL - Youth XL - Adult
(2) Dietary Restriction?

Yes No
(2) List Restrictions:
Register 3rd participant?

Yes No
Participants 3:

First Name Last Name
(3) Age:
(3) E-mail:
(3) School:
(3) First time attendee?

Yes No
(3) T-Shirt Size?:

S - Youth S - Adult M - Youth M - Adult L - Youth L - Adult XL - Youth XL - Adult
(3) Dietary Restriction?

Yes No
(3) List Restrictions:
Register 4th participant?

Yes No
Participants 4:

First Name Last Name
(4) Age:
(4) E-mail:
(4) School:
(4) First time attendee?

Yes No
(4) T-Shirt Size?:

S - Youth S - Adult M - Youth M - Adult L - Youth L - Adult XL - Youth XL - Adult
(4) Dietary Restriction?

Yes No
(4) List Restrictions:
Register 5th participant?

Yes No
Participants 5:

First Name Last Name
(5) Age:
(5) E-mail:
(5) School:
(5) First time attendee?

Yes No
(5) T-Shirt size?:

S - Youth S - Adult M - Youth M - Adult L - Youth L - Adult XL - Youth XL - Adult
(5) Dietary Restriction?

Yes No
(5) List Restrictions:
Parent/Guardian:

First Name Last Name
E-mail
Phone Number

- Area Code Phone Number
My daughter(s) has participated in the past:

Delta Academy Delta GEMS Neither
Would you like information on:

Delta Academy (11-14 yrs) Delta GEMS (14-18 yrs)
How did you learn of this event?: *

I participate in Delta Academy/Delta GEMS A member of Delta Sigma Theta Sorority, Inc. Friend Social Media Community Calendar Event Flyer Church
Which Chapter?: *

Evanston North Shore Alumnae Chapter
Which Social Media *

Evanston North Shore Alumnae Chapter's Facebook Page Another Facebook Page Twitter
I am registering:

Myself (18 or older) My Child(ren)

My Black is BEAUTIFUL

Please read the information below and complete the electronic signature. If you're 17 years of age and younger a parent or guardian must complete this sections. See below for group registrations

Waiver and Release Form

In signing this release I acknowledge that my child(ren)/I will be participating in and attending the My Black Is Beautiful event for Delta Sigma Theta Sorority, Incorporated Evanston North Shore Alumnae Chapter. I acknowledge that they are/I am physically fit and able to safely participate in the event without risk to themself or others. I understand that there may be risks associated with participating in a physical activity and assume all risk of injury that may occur as a result of participating in the event. I, for myself, my heirs, executors and administrators, hereby agree to indemnify and hold harmless Delta Sigma Theta Sorority, Incorporated, Evanston North Shore Alumnae Chapter (ENSA) and Members, Evanston Township High School, all public or private agencies whose property and/or personnel are used, all other sponsoring or co-sponsoring companies or individuals and all individual organizers or volunteers related to or involved in the event (collectively "Releasees") from all liability to my child(ren)/myself and my personal representatives, assigns, heirs and executors, for all loss(es) or damages(s) and any and all claims or demands therefore, on account of injury to myself or property. I assume the risks of loss(es), damages(s), or injury(ies) that may be sustained by my child/myself while participating in the aforementioned activity.

I consent to Evanston North Shore Alumnae Chapter (ENSA) to taking photos and/or videos of my child(ren)/myself during the activity listed above. I understand that I am consenting to use of said photos and videos in printed materials, social media, videos, and presentations without any compensation.

PARTICIPANT HAS READ THE FOREGOING AND INTENTIONALLY AND VOLUNTARILY ACCEPTS THIS RELEASE AND WAIVER OF LIABILITY AGREEMENT.
By signing I acknowledge and accept the terms *
All questions should be emailed to MBIB@dstevanston.org.

_________________________________

Group Registration: To print or download waiver, place your cursor in the black area of the wavier. All waivers should be emailed to the email address above prior to the event.
Waiver & Release Form
Should be Empty: