Debutante Interest Application Form

The Distinctively Debs 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.

Please review all the instructions before beginning. There will be requests for you to upload files and gain consent from a parent or guardian during this application.

Step 1 of 4

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Debutante Information

Your Name(Required)

First Last

Upload Your Headshot(Required)

Accepted file types: jpg, png, pdf, Max. file size: 1 MB.

Upload Your Interest Letter(Required)

Accepted file types: pdf, docx, Max. file size: 1 MB.

Upload two (2) letters of recommendation(Required)

Drop files here or

Accepted file types: pdf, docx, Max. file size: 1 MB, Max. files: 2.

Your Email(Required)

Enter Email Confirm Email

If you don't have your own email address, use a parent or guardian's email.

Your Phone(Required)

If you don't have your own phone, use a parent or guardian's phone number.

Debutante Grade(Required)

Please enter a number from 5 to 12.

Your Age(Required)

Your Date of Birth(Required)

Month

Day

Year

In Person or Virtual(Required)

In Person

Virtual

Hybrid

Debutante T-Shirt Size (Ladies)(Required)

XXL

Your Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Do you speak any languages other than English?(Required)

Yes

What other language(s) do you speak?

Your Favorite Hobby(Required)

Your Favorite Food(Required)

Your Favorite Book(Required)

Your Favorite Author(Required)

Your Favorite Scripture(Required)

Your Favorite Subject(Required)

Your Favorite Color(Required)

What are some of your favorite things to do with friends?(Required)

What are some things that interest you outside of school?(Required)

If you could learn about a job or career, what would it be?(Required)

If you could learn something new, what would it be?(Required)

Name a person you admire the most and why.(Required)

Describe your perfect Saturday.(Required)

Mother's Contact Information

Name

First Last

Phone

Does your mother have a different mailing address from you?(Required)

Yes

Mailing Address

Street Address Address Line 2 City State ZIP Code

Father's Contact Information

Name

First Last

Phone

Does your father have a different mailing address from you?(Required)

Yes

Mailing Address

Street Address Address Line 2 City State ZIP Code

Distinctively Debutantes Program Guidelines

Debutantes should check the box signifying their understanding and agreement to follow all program guidelines.

Debutante must respect the rights, privileges, and property of other Debutantes, the Distinctively Debutante Program, and our supporting staff.(Required)

Debutante must demonstrate exemplary moral standards and active engagement in their community.(Required)

Debutantes must observe and follow any guidelines set by the Distinctively Debutante Program.(Required)

Debutante must maintain a minimum cumulative GPA of 2.5 on a 4.0 scale throughout the program(Required)

I, ________________________________, have read and understand the following “Guidelines for Debutantes” and will abide by the expectations described above. I understand that if I fail to meet the guidelines set by the Distinctively Debutante Program, my status will be subject for review, which may result in the possibility of my placement in the program being revoked.(Required)

Your Full Name

I, ________________________________, parent or guardian of the above debutante, have read and understand the following “Guidelines for Debutantes” and understand that the debutante is required to abide by the expectations described above. I understand that the debutante fails to meet the guidelines set by the Distinctively Debutante Program, the debutante's status will be subject for review, which may result in the possibility of the debutante's placement in the program being revoked.(Required)

Your Full Name

Parent/Guardian Forms

Please ask a parent to fill out this portion of the form.

Person(s) authorized to pick up or take custody of the child/student, other than the parent/guardian signing below, is/are as follows:

Does your Debutante have any medical condition or special needs?(Required)

Yes

In transporting or supervising my child, Distinctively Her and The TD Jakes Foundation should be aware of the medical condition or special needs of my child as follows:

Photography & Media Consent(Required)

By participating in Distinctively Her and T.D. Jakes Foundation programming, guardians acknowledge and consent to all photography, video recordings, and other media captured during program activities. All such media will remain the sole property of the organization and may be used for promotional, educational, and archival purposes without further consent or compensation.

Communication Consent

This section is intended as a means of informing and gaining the consent of the parent/guardian to allow their daughter to personally communicate with their mentors while participating in the Distinctively Debutante Program. Please check the consent box(es) by the Mentor-Debutante communication style that best suits your Debutante.

I give my informed consent and permission for my Debutante to receive emails from her assigned mentor. Note: Debutante Coordinator and co-mentor will be blind copied.

I give my informed consent and permission for my Debutante to receive emails from her assigned mentors with Parent/Guardian copied.

I give my informed consent and permission for my Debutante to receive phone calls from her assigned mentors.

I give my informed consent and permission for my Debutante to receive text messages from her assigned mentors.

I give my informed consent and permission for my Debutantes to receive group text messages from her assigned mentors.

Student Driver Liability Release

Do you have (or are you) a student driver?(Required)

Yes

I give my Debutante permission to drive herself to/from the sessions of The Distinctively Debutantes Program located at The Potter’s House of Dallas (6777 W. Kiest Blvd Dallas, TX 75236).

I understand that The Distinctively Debutantes Program and The TD Jakes Foundation is not responsible for any damages/harm resulting from operation of the motor vehicle. I also give my Debutante Permission to check herself in and out of all sessions, thereby allowing her to be released from the property without parent/guardian supervision.

I confirm that I have carefully read this CONSENT AND RELEASE and agree to its terms knowingly and voluntarily.

I also confirm that I am the parent or legal guardian of the student/debutante or I am a student/debutante 18 years or older.

Please list any additional debutantes that will be transported by approved student driver.

Student Driver's Full Name

Student Driver's License Number

Include the State (e.g. TX 12345678)

Full Release of Liability

I understand that this is a TD Jakes Foundation function primarily on the Potter’s House of Dallas 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: Distinctively Debutante classes and related activities, I undersign Parent/Guardian/Releaser (herein afterward referred to as “Releaser”), 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 Releaser 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, Releaser, 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.

Further, I Releaser, 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.

Today's Date(Required)

Month

Day

Year

Full Release of Liability(Required)

By signing below, I agree to all the above terms and conditions, confirm my consent for communications with my Debutante, and if applicable, release liability for my student driver. Kindly type your FULL NAME below to signify signature and agreement.

Phone

This field is for validation purposes and should be left unchanged.