B1-PARENTAL/GUARDIAN AFFIRMATION

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.