"Believe In Yourself....The Future Begins With Me!" Scholarship Workshop Registration Form

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Presented by the San Antonio Alumnae Chapter of Delta Sigma Theta Sorority, Inc.
A DreamWeek Event
Date: January 22, 2022
Time: 9:00 am--1:00 pm (CST)
For: Students in grades 9th-12th
Place: Webinar
Cost: Free
Contact: SAAC2ndVP@gmail.com

*Deadline to submit registration form is 11:59 pm (CST) January 14, 2022 (Registration is now closed)

Email *

Participant's Name *

Participant's Address *

Participant's grade (If a student; otherwise, type N/A) *

Participant's Age (If a student; otherwise, type N/A) *

Participant's School/Organzation (If attendee is a parent, please type "Parent") *

Parent/Guardian Name (If under 18; otherwise, type N/A) *

Parent/Guardian Phone Number (If under 18; otherwise type N/A) *

Emergency Contact Name (If under 18; otherwise, type N/A) *

Emergency Contact Phone Number (If under 18; otherwise, type N/A) *

As part of the webinar, the use of photography/videography will only be used to augment the development of the students positively and constructively. I consent to the use of photography/videography of my child for the purpose of the webinar event. Attending adults type N/A in "Other" *

Yes

Other:

During the webinar, I understand that panelist may discuss age-appropriate information on sensitive issues including but not limited to sensitive topics surrounding civic engagement within our community. I acknowledge and permit my child who is under 18 years of age to participate fully in the upcoming webinar. Attending adults type N/A in "Other" *

Yes

Other:

By submitting this registration form, I certify that I have reviewed it in its entirety and that the information provided is correct to the best of my knowledge. My child has permission to attend this webinar. Please type your full name below. *

Submit

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