2026 Debutante Escort Application

2026 Debutante Ball Escort Application

The Dayton Alumnae Chapter of Delta Sigma Theta Sorority, Inc. is pleased that you will be an Escort in the 2026 Debutante Ball. We look forward to a fun-filled Debutante Season. Please complete this form NO LATER THAN SUNDAY, JANUARY 25, 2026.

To Be Completed by Escort

PLEASE CAREFULLY READ THE FOLLOWING STATEMENT: All eligibility criteria must be maintained throughout the Debutante Season. The Dayton Alumnae Chapter of Delta Sigma Theta Sorority, Inc. reserves the right to dismiss those who fail to maintain eligibility. No refunds will be issued.
Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*

Area CodePhone Number
Age*
Birthdate *

Academic Information
School Now Attending*
What is your academic standing?

High School JuniorHigh School SeniorCollege Student
Please upload a letter on school letterhead from a school counselor, teacher, or professor stating you are a student in good standing.*

Cancelof
Student Signature*

Clear
Date*

MonthDayYear
Date

Media Release Form

Must be completed by the parent(s) or legal guardian(s) of the escort OR by an escort 18 or older.
I/We,   First Name*   Last Name*  and/or  First Name*   Last Name*  ( "Parent/Guardian"), as parent(s) or guardian(s) of Escort,   First Name*   Last Name*   permit the Dayton Alumnae Chapter of Delta Sigma Theta Sorority, Inc. (the "Chapter") to publish in the media or on the Internet any and all still photographs or moving images, including, if applicable any sound recordings accompanying the images ("images") taken of my/our child at any Debutante Ball Program activity 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 future Debutante Ball Programs, or for any other lawful purpose. In addition, I waive my 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 Dayton Alumnae Chapter and any of its officers and members, Delta Sigma Theta Sorority, Inc. and its officers, including, 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 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 and/or legal guardians of Escort    First Name*   Last Name*   , OR I certify that I am an Escort of legal age, and do hereby give my/our consent without reservation to the foregoing Photograph and Video Authorization and Release on behalf of my/our child OR on my own behalf.

Signature*   Date*
Should be Empty:

2026 Debutante Ball Escort Application

To Be Completed by Escort

Academic Information

Media Release Form