Omega Lamplighters | Official Website of America's Premier Youth Leadership Organization

Omega Lamplighters Application 2018-2019

OMEGA LAMPLIGHTER APPLICATION
(2018-2019)


APPLICATION DEADLINE: MONDAY, APRIL 30, 2018


 
Applicant's Name *
Applicant's Name
Primary Home Address *
Primary Home Address
Student's Phone Number *
Student's Phone Number
Student's Secondary Number *
Student's Secondary Number
Primary Parent/Guardian *
Primary Parent/Guardian
Parent's Primary Phone Number
Parent's Primary Phone Number
Parent/Guardian's Secondary Phone Number
Parent/Guardian's Secondary Phone Number
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone Number *
Emergency Contact Phone Number
Please be prepared to provide official documentation denoting volunteer hours completed.
Health Information
Primary Doctor's Name
Primary Doctor's Name
Code of Conduct/Parental Release Clause
I hereby grant permission for my child to participate in the Tallahassee Omega Lamplighters Club governed by Omega Psi Phi Fraternity, Inc. and to participate in activities arranged by the Youth Club's Committee and Advisor in this regard from time to time. This will serve to release Omega Psi Phi Fraternity, Inc. and all of its affiliates from liability in case of accident or injury resulting from all causes in connection with such membership including outings, field trips or other activities which necessitate travel away from Tallahassee, Florida, except for those involving gross negligence or intentional misconduct on the part of Omega Psi Phi. In granting this permission and release, I specifically recognize that my child may from time to time be transported to events by private vehicles operated by advisors or Omega Fraternity members. I specifically release and will hold harmless Omega Psi Phi Fraternity, Inc. their officers, members, etc. any and all liability which may arise as a result of such transportation. The health history I provided is correct as far as I know. The person herein described has my permission to engage in all prescribed activities except as noted above. The following authorization empowers the staff of Omega Lamplighters Youth Group to take whatever steps they deem necessary to ensure the well-being of your child should a medical emergency occur during a youth group meeting/activity. Every attempt will be made to contact the parent or emergency contact provided. I do hereby authorize the staff of Omega Lamplighters Youth Group to take necessary emergency measures when treatment of my child is needed. My son is in good physical health and does not have any disabilities which may be aggravated except as noted on this form. I release Omega Psi Phi and its members from all responsibilities other than supervised, scheduled activities. In the event that I cannot be reached in an emergency, I hereby the authorize the physician selected by Omega Psi Phi to hospitalize, secure proper treatment for, and order injections, anesthesia and surgery for my child named above. I agree to the following code of conduct for participation in the program for the 2018-2019 academic year: 1. Possession and use of any drug, marijuana, tobacco, or alcohol is strictly forbidden. Violations will result in immediate dismissal from the event and will be expelled from the program. 2. Attendance at all aspects of an event is mandatory. Three absences from mandatory meeting will result in expulsion from the program. 3. No participation in any event or failure to attend any part of an event without the expressed consent of their parent and the acknowledgement of the advisor may result in expulsion from the program. No participant may leave the grounds of any sanctioned Omega Lamplighters event without the expressed permission of the advisor. 4. Any rules announced by the advisor/leadership of the event are to be observed as if they were written rules. 5. All local, state and federal laws shall be in force. 6. No foul language or disruptive behavior (as determined by the advisor) will be tolerated. 7. At all times during an event, participants are expected to show respect and courtesy to advisors, chaperones and all other Omega Lamplighter Youth Group participants. The participant’s parents will be notified immediately if any of the rules are broken. Anyone who does not follow these rules will not be allowed to participate in future events and risks dismissal from the Omega Lamplighters Youth Group. Any member who is dismissed from the program will forfeit all Omega Lamplighter paraphernalia and money paid to the program. I understand the above outlined Code of Conduct: Events of Omega Lamplighters and agree to follow such Code. I agree to allow my child to attend field trips this year. Parents will be notified in advance of the dates and destinations of all trips. My child has permission to go on all Omega Lamplighters Youth Group trips for the 2018-19 school years at the parent's discretion. Please be advised that Omega Lamplighters is an entity sponsored by Omega Psi Phi Fraternity, Inc., however its participants are not considered or affiliated as members of the fraternity. PHOTOGRAPHY/VIDEOGRAPHY RELEASE I hereby grant permission for the Omega Lamplighters Club to use photographs for use in any and all media and methods of transmission and/or distribution now or hereafter known, including but not limited to film, print, video, computer, Worldwide Web, Internet Website, Email, FTP, computer network, and digital reproduction and distribution, for illustration, art promotion, advertising, trade, sales, or any other purpose whatsoever. I hereby waive any right to inspect or approve the photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to organization or unknown, including but not limited to any re-use, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur in relation to the finished product. I hereby agree to hold harmless the Omega Lamplighters Club from and against any claims, and waive any right to royalties or other compensation arising from or related to the use of the photographs.
By entering your full legal name into the field below, you are acknowledging you have fully read the code of conduct/parental release clause listed above. The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability and admissibility.
By entering your full legal name into the field below, you are acknowledging you have fully read the code of conduct/parental release clause listed above. The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability and admissibility.
Date of Submission *
Date of Submission
NEXT STEPS
Please obtain TWO letters of recommendation and send via email to lamplighters850@gmail.com. One must come from either a school faculty member or past teacher. The second can come from a coach, pastor, mentor, etc. Please have the following questions answered in your letter of recommendation (Must not exceed 250 words): 1. Why would it be good for this applicant to participate in the Omega Lamplighters Club? 2. What character attributes have you experienced from the applicant that would make him a valuable person to have in our program? Please illustrate how you have observed these attributes. An official transcript with the seal of the school MUST accompany your letters of recommendation. Payment will be accepted IN FULL upon receipt of all required documentation. Application Drop Off Locations: Connie Williams Jack Mclean 700 Paul Russell Road Tallahassee, FL 32301 P.O. Box 6252 Tallahassee, FL 32314 Palmer Munroe Teen Center 1900 Jackson Bluff Rd. Tallahassee, FL 32304
Program Benefits
The Omega Lamplighters is an organization dedicated to helping Big Bend Area young men of high school age to grow and develop their leadership talents in every phase of life. The organization models the fraternity whereas active leaders and achievers in the community are sought out. Former members of Omega Lamplighters included standout athletes, school government leaders, scholars, etc. The common bond between young men in the program mirrors the aim of the fraternity; to produce the greatest thinking minority males in the Big Bend. Please be advised that Omega Lamplighters is an entity sponsored by Omega Psi Phi Fraternity, Inc., however its participants are not considered or affiliated as members of the fraternity. Through club oriented activities, Omega Lamplighters perform projects that will expose young men to planning, execution, reporting ideas, and simulating good leadership characteristics designed to raise their aspiration levels. All activities and programs are modeled around the following four phases: Leadership Academics Maturity Perseverance Numerous hours of community service (essential for college consideration). College Grants and Scholarship (merit and need based). A minimum of $500 is given to each senior for participation in the program. Participants are also eligible for up to $5000 in scholarships through the fraternity and its affiliates. Mentorship and partnership with the esteemed Omega Psi Phi Fraternity, Inc. (which include members such as Steve Harvey, Michael Jordan, Ray Lewis, Rickey Smiley and Shaquille O’Neal). ACT/SAT/College Application waivers and tutoring opportunity. Local and National networking opportunities. Should you have any questions regarding the program, please feel free to contact Royle King (214) 364-2921 | Larry Harris (850) 702-4947 or via email at Lamplighters850@gmail.com. Thank you for your consideration.