STARR - Students Talking About Race and Racism Application 2023

STARR: Students Talking About Race + Racism is a 2-day, non-residential NCCJ program for students interested in learning about the current and past manifestations of race and racism in our country. Click here to learn more about STARR.

STARR will take place at YWCA High Point on Saturday, September 9th and Sunday, September 10th, 2023. Thanks to a generous grant from Foundation for a Healthy High Point and other funds, tuition is free for up to 24 Triad area high school students Spots are limited to 24 students, so get your application in as soon as possible

By checking the text opt-in box you are agreeing to receive periodic SMS and/or MMS message from this organization. Message and data rates may apply. Text HELP for more information. Text STOP to stop receiving messages

To ensure diversity at STARR, we ask that you please check any/all of the following that apply to you: (This information is confidential and will be viewed by NCCJ staff only. It will not be used or disclosed for any other purposes.)

All medical information will be kept strictly confidential.

This section should be completed by a parent or guardian.

Food cannot be prepared to order. However, the we will do our best to accomodate dietary requests. (We do not have a kosher or halal kitchen.)

This health history is correct and complete as far as I know, and my child/the child in my care has permission to participate in the program activities except as noted. I also understand that NCCJ of the Piedmont Triad, Inc., its officers, board members, volunteers, agents, employees and licensees cannot be held liable for any health complications or problems that resulted from or were caused by my child's/the child in my care's negligent regard for his/her own health and safety.

I understand and agree to abide by the restrictions placed on my activities during this program. I agree not to infringe on the safety of or knowingly cause bodily harm to the others in attendance at STARR. I also understand that NCCJ of the Piedmont Triad, Inc., its officers, board members, volunteers, agents, employees and licensees cannot be held liable for any health complications or problems that resulted from or were caused by my negligent regard for my own health and safety.

Photo Release
I am the parent/legal guardian of this applicant who will be participating in activities sponsored by the NCCJ of the Piedmont Triad, Inc. including STARR. I understand that my child/the child in my care, alone or with other participants and/or NCCJ of the Piedmont Triad, Inc. staff, volunteers or representatives, may be interviewed, photographed, recorded on film, audio tape, video, or other visual and sound computerized, telephonic, voice-mail or tape media ("photographs and/or sound/image recordings") and/or may provide written or oral statements to NCCJ of the Piedmont Triad, Inc. and/or others approved by NCCJ of the Piedmont Triad, Inc.

I hereby consent to the foregoing and grant permission, without reservation, to NCCJ of the Piedmont Triad, Inc. and/or those approved by NCCJ of the Piedmont Triad, Inc. to generate, prepare, advertise, describe, and/or publicize NCCJ of the Piedmont Triad, Inc. and its work, good will, public education and/or fundraising activities, disseminate, otherwise use and comment upon the photographs and/or sound/image recordings as they may determine, without review by me or my child/the child in my care and without financial or other obligation of any nature to me or my child/the child in my care. I consent that my child/the child in my care may be identified by name, age, race, school of attendance, city of residence, or program of participation as these companies and/or those approved by these companies may determine. Uses may include, but are not limited to, promotional videos, fundraising appeals, website content, and news coverage.

I release NCCJ of the Piedmont Triad, Inc., its officers, Board of Directors, volunteers, agents, employees and licensees from all claims that I or my child/the child in my care may have, or might have, for any cause of action arising out of the taking and/or use of the photographs and/or sound/image recordings as set forth herein. This consent and release shall continue in effect, without a limitation of time.