the Application

 2015 – 2016 Application
“ I am a Princess and my Father is the
King of Kings”
Want to mail it?
WoMan-to-Woman
Attn: Distinctively Debs
6777 West Kiest Boulevard
Dallas, TX 75236
Submit your application today!
Want to email it?
[email protected]
Want to drop it off?
WoMan-to-Woman Table
Lobby @ TPH
Sundays and Wednesdays
1 DISTINCTIVELY DEBS DEBUTANTE PROGRAM
VISION STATEMENT
The debutante program was birthed from the vision of First Lady Serita Jakes, and designed to
equip developing young women with essential life teachings in social, professional, personal, and
spiritual growth. The main pillars at the center of the program’s framework are:
 Deliver knowledge on the mind, body, and spiritual development of a woman of God
 Encourage passion, drive, and ambition in professional and personal endeavors
 Instill grace, poise, confidence, and femininity within the young women
 Promote sisterhood and unity amongst the Debutantes
The Debutantes are chosen based on the following criteria:
 Must demonstrate and maintain scholastic achievement
 Must demonstrate a focus on goals and aspirations beyond high school
 Maintain membership in good standing at a local church
 Must demonstrate outstanding character, leadership, dependability, and morality
 Commit to service in school or in the community
Trained mentors will be assigned to work with the Debutantes, and are required to present
before them an exemplary lifestyle. Sessions in faith, etiquette, chastity, finance, education, and
interpersonal relationships are addressed during the Debutantes’ seven months of training from
August to February. The end of their training culminates with a Cotillion when the debutante
reaches the Core group.
2 APPLICATION
CRITERIA
To be considered for the Debutante Program, candidates must possess the following criteria:
u Must be a female between the ages of 10 and 17 years
u Maintain a cumulative GPA of 2.75 and above
Applicants who have not reached a 2.75 can be considered admission under probationary terms.
u Must be in good standing at a local church
u Must be willing to commit to service in the community and school throughout the
duration of the program
New prospective candidates must submit the following to be considered for the 2015 – 2016
program:
u A current transcript or report card signed by the appropriate counselor or principal
u Proof of current health insurance
u Three letters of recommendation from a teacher, counselor, school administrator,
mentor, or organization
u A one-page letter of interest that includes the applicant’s hobbies, interests, goals,
and aspirations. This document should also include a statement of what salvation in
Jesus Christ means to you
u A current 3x5 head shot photograph of the candidate
Returning Debutante candidates that will not be transitioning into a new program need only to
submit a recent transcript or report card and a current copy of the applicant’s proof of health
insurance.
3 APPLICATION
INFORMATION
The Debutante Program will be made available to the following age groups:
u Core Debutante: 16 and 17 years of age or 12th grade of high school
u Junior Miss Debutante: 13 to 15 years of age
u Junior Debutante: 10 to 12 years of age
Prior to the final selection of Debutante Program participants, each candidate will be scheduled
for a short interview with designated members of the Debutante Program Committee. Prior to
the deadline, the completed application packet must be returned to the WoMan to Woman
Ministries table before or after Service on Sunday or Wednesday. Any questions regarding the
program, application, or other information may be directed to the Distinctively Debs Program
Coordinator, Cheray Waters, at (214) 339-0410.
PRICING
Early Registration: March 1 – May 31
Debutante Candidates
Fees
Regular Registration: June 1 - See deadlines
Debutante Candidates
Fees
Core Debutante
$250.00
Core Debutante
$300.00
Junior Miss Debutante
$200.00
Junior Miss Debutante
$250.00
Junior Debutante
$150.00
Junior Debutante
$200.00
Returning Debutante
$125.00
Returning Debutante
$175.00
Summer Boot Camp
Included
Summer Boot Camp
$50.00
All money orders and checks should be made payable to The Potter’s House of Dallas.
Please check at the time of registration for early registration discounts and scholarships.
4 APPLICANT INFORMATION SHEET
General Student Information
Candidate’s Full Name
Last Name
Birthdate:
First Name
Middle
Home Phone:
Nickname
Mobile:
Applicant’s Email:
Home Church:
Applicant lives with:
(Relationship to applicant) Parent/Guardian Information
Father/Guardian’s Full Name:
Last
First
MI
Home Address:
Street
City
Home Phone:
Cell:
Fax:
Work:
Occupation:
State
Zip
Work:
Email:
Company Name:
Position/Title Parent/Guardian Information
Mother/Guardian’s Full Name:
Last
First
MI
Home Address:
Street
Home Phone:
Cell:
Fax:
Work:
Occupation:
City
State
Zip
Work:
__________________
Email:
Company Name:
Position/Title 5 APPLICANT PROFILE SHEET
ABOUT ME
F
A
V
O
R
I
T
E
S
Hobby:
Book:
Attach Current Headshot here Author:
Scripture:
Academic History
Please attach current transcript or report card
Advisor/ Counselor:
Grade Level:
School:
Phone:
Applicant’s extracurricular activities, co-curricular interests, and achievements:
6 FULL RELEASE OF LIABILITY
I understand that this is a Church function primarily on the Church grounds, therefore my
conduct and attitude will be respectful to others at all times.
In consideration of being permitted to participate in the following activities: The Potter’s House
Debutante classes and related activities, I undersign Parent/Guardian/Releasor (herein
afterward referred to as “Releasor”), for myself, my child, my family, legal representatives, heirs,
and assigns, do hereby release agree to hold harmless, defend and indemnify The Potter’s House
and T.D. Jakes Ministries, Inc., and their officers, directors, employees, and agents, (herein
afterward referred to “Releasee”) from any claim, demand, action, or right of action, in law or in
equity, foreseeable or unforeseeable, arising from any injury to Releasor or Releasee’s child or
family members, even injury resulting in death, whether caused by the active or passive
negligence of Releasee, myself, my child, my family, or other cause which may occur as a result of
my family’s participation in the above activities.
I, Releasor, personally assume full responsibility for the risks of bodily injury, death, or property
damage arising from participation in the above activities. I certify that I have learned or will
learn proper use if any equipment necessary to participate in the above activities prior to using
that equipment. I have inquired about the above activities to my satisfaction and I am aware of
the inherent risks and dangers of the above activities and benefits to be gained by engaging in
the activities.
I, Releasor, expressly agree that this assumption of risks, full release, indemnity and hold
harmless for future injuries agreement is intended to be as broad and inclusive as permitted by
the laws of the State of Texas and that if any portion thereof is held invalid it is agreed that the
balance shall not withstand to be in full legal force and effect.
Further, I Releasor, state that I understand the terms of this agreement and release are
contractual and not merely recital; I have fully informed myself of this agreement and release by
reading it before signing it; I have had the opportunity to consult with legal counsel regarding
the effect of this agreement and release. I have signed the document of my own free will.
DO NOT SIGN THIS RELEASE IF YOU DO NOT UNDERSTAND AND/OR AGREE WITH THE TERMS.
Signatures:
Parent/Guardian/Releasor
Date
Parent/Guardian/Releasor
Date
Participant
Date
7 PARENTAL CONSENT AND RELEASE
The Potter’s House of Dallas, Inc. (“Church”) is organizing and planning a certain event, trip, or activity generally
described as follows: Debutante Program (the “Event”). I wish for my child to participate in the event.
Please print all answers legibly. Do not leave any blanks. If the answer is none, then write “none” in the space
provided.
Student’s Name
Age
Grade
Address
City
Zip
Email Address
Parent/Guardian
Home Phone
Cell Phone
Emergency Contact
Phone
Person(s) authorized to pick up or take custody of the child/student, other than the Parent/Guardian signing below,
is/are as follows:
In transporting or supervising my child, the Church should be aware of the medical condition or special needs of my
child as follows:
To be completed by the parents or legal guardians of students under 18 years of age.
I, _________________________, the parent and/or legal guardian of ___________________, a minor (“child”) hereby
acknowledge and agree as follows:
1. My child may participate in the event, whether it is on or off church property and Church personnel or
Church volunteers may transport she/he to and from the event.
2. If my child is injured or needs medical attention while participating in the event, I give the church, its
employees, and volunteers permission to seek medical diagnosis and treatment which in their best judgment
they deem to be necessary or appropriate under the circumstances.
3. I also agree to fully release and hold harmless the Church, its pastors, employees, agents, borrowed
servants, contractors, and other workers, paid or volunteer, or their hairs and assigns, from any and all
injuries, claims, liabilities, or causes of action which may arise from the transportation or participation of
my child in the event.
Parent and/or Legal Guardian _______________________________________________ Date ________________________
Signature
State of Texas, County of ______________________
Sworn to and subscribed before me on the ______ day of ____________, 20___ by _________________________________.
_______________________________________
Notary Public, State of Texas
8 APPLICATION SUBMISSION CHECKLIST
To ensure your application is completed in its entirety, please use this checklist as a guide to ensure all documents are
included upon submission.
Boot Camp Deadline is July 12, 2015
Program Deadline is September 6, 2015.
Completed Application
Current Report Card/Transcript
Letters of Recommendation
Applicant’s letter of interest
Proof of Insurance
Current Headshot
Signed Full Release of Liability
Signed and Notarized Parental Consent and Release
Appropriate payment made payable to The Potter’s
House of Dallas
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