C.H.O.I.C.E.S. Experience® 2026–2027

The C.H.O.I.C.E.S. Experience^® and B.U.I.L.D. Mentoring Collective^SM

Student Permission SLIP 2026–2027

The Image Initiative, Inc., an organization dedicated to the empowerment of young women, presents the C.H.O.I.C.E.S. (Creating Heightened Opportunities in Community Environment and Self) Experience^®, which provides skill development/life enhancement workshops for young women from underserved populations, ages 13–18, who reside in Onondaga County, New York. These workshops seek to assist in their development as productive young women and citizens. To learn more about The Image Initiative, Inc. and the C.H.O.I.C.E.S. Experience^®, visit us at www.imageinitiative.org or click here.

The C.H.O.I.C.E.S. Experience^® will take place on *Wednesdays (dates listed below or see calendar link) from 2:00 p.m. to 3:30 p.m. for the 2026–2027 academic year. *Except for the Sisters Empowering Sisters (SES) Conference on April 22-23, 2027.

Please note: Students must participate in ALL workshop sessions.

Session Dates

Select any date to add it to your calendar or click here to add all dates to your calendar.

October 21, 2026
November 4, 2026
November 18, 2026
December 2, 2026
December 16, 2026
January 13, 2027
January 27, 2027
February 10, 2027
February 24, 2027

March 10, 2027
March 24, 2027
April 7, 2027
April 22–23, 2027 (SES Conference)
May 5, 2027
May 19, 2027
June 2, 2027
June 16, 2027
June 30, 2027 (Final Session)

Program Facilitators

Ms. Adara Hobbs ~ ahobbs@imageinitiative.org or 315-575-4081
Ms. Trinity Benton ~ tbenton2@scsd.us

Parents/legal guardians: Please complete and check EACH required section below. Students will not be allowed to participate in any sessions without a completed permission slip.

Student Name *

First

Last

School Name: *

Grade *

Student Age *

Student Cell Phone Number *

Home Phone Number

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Do you have any food allergies? If so, please list them below: *

Enter "None" if no allergies.

Do you currently have a part-time job? *

Please list the days and hours you work.

Do you currently attend any of the following programs?

STEP
Upward Bound
None of these

Parent/Legal Guardian Full Name *

First

Last

Parent/Legal Guardian & Emergency Contact

Parent/Legal Guardian Cell Phone Number: *

Parent/Legal Guardian Email: *

Emergency Contact Name: *

First

Last

Emergency Contact Phone Number: *

Parental Permission & Acknowledgements

Permission to Participate

Please review and confirm your permission for your child to participate in the C.H.O.I.C.E.S. Experience for the 2026–2027 academic year. *

I give permission for my child to participate in The Image Initiative, Inc.’s C.H.O.I.C.E.S. Experience on the 18 dates listed above. I understand that dates are subject to change and that I will be notified as far in advance as possible.

B.U.I.L.D. Mentoring Collective

C.H.O.I.C.E.S. Experience participants have the opportunity to be matched with mentors through the B.U.I.L.D. Mentoring Collective. For more information on the B.U.I.L.D. Mentoring Collective, click here.

Check the box below ONLY if you DO NOT want your child to participate in B.U.I.L.D. Mentoring Collective.

I do not consent to my child participating in B.U.I.L.D. Mentoring Collective.

Criteria for Participation

Criteria for Participation in the C.H.O.I.C.E.S. Experience Workshop Series

Participants must:

Show leadership qualities in any area of their background (church, sports, community groups, school, etc.). If they have no prior leadership experience, they must show evidence of confidence, strength of character, determination, and independence.
Be able to set both short-term and long-term goals
Be willing to learn about their strengths and weaknesses (academic, social, and emotional), work hard at self-development, and broaden their individuality.
Accept instruction and support with ease.
Communicate thoughts and ideas effectively, verbally and in writing; process complex ideas; and be willing to share their thoughts.
Show service to others in their community, such as helping at home, school, or their neighborhood. If they have not had the opportunity, they must be willing to serve.
Understand that attendance is mandatory (see Attendance Expectation below) and be willing to contribute and participate.

Please acknowledge your agreement to these criteria. *

I have read the Criteria for Participation, and my child and I understand and agree to them.

Attendance Expectation

C.H.O.I.C.E.S. is a connected program, and each session builds on the one before it. Students are expected to attend all 18 scheduled sessions (October 21, 2026 through June 30, 2027), including the SES Conference on April 22–23, 2027. Please review the session dates above and let us know now if you anticipate any conflicts.

If your child must miss a session, please notify a group facilitator (contact information above) by call, text, or email at least [24 hours] in advance, or as soon as possible in an emergency. After [two] unexcused absences, a staff member will contact you to talk through any barriers and make a plan. Continued absences may affect your child’s continued participation in the program.

Please acknowledge your agreement to this expectation. *

I have read and understand the attendance expectation, and I will support my child in attending all C.H.O.I.C.E.S. sessions.

Photo/Video Release *

I give permission to The Image Initiative, Inc.’s C.H.O.I.C.E.S. Experience, its agents, assigns, and/or newspapers, radio, or television to use my child’s photographs (whether still, motion, video, television, internet, or Image Initiative website) for publicity regarding this program.
I do not give permission to The Image Initiative, Inc.’s C.H.O.I.C.E.S. Experience, its agents, assigns, and/or newspapers, radio, or television to use my child’s photographs (whether still, motion, video, television, internet, or Image Initiative website) for publicity regarding this program.

Liability Waiver and Release *

I am the lawful parent/legal guardian of the student listed above, and I consent to my child’s participation in the C.H.O.I.C.E.S. Experience. I understand that participation, at any level, is at my child’s own risk and that, although rare, illness, injury, or death could result. I am using my own capacity and assessment of risk in deciding to allow my child to participate, and I voluntarily make that decision with full awareness that risks may be involved. By allowing my child to attend any session or activity with the C.H.O.I.C.E.S. Experience and/or The Image Initiative, Inc., I expressly assume all risk of accidental personal injury, sickness, death, damage, and expense resulting from my child’s participation.

Release of Liability *

In consideration of The Image Initiative, Inc. allowing my child to participate in all activities related to the C.H.O.I.C.E.S. Experience (inclusive of B.U.I.L.D. Mentoring Collective, if applicable), I release, forever discharge, and agree to hold harmless The Image Initiative, Inc. and its directors, officers, partners, managers, employees, volunteers, agents, successors, attorneys, and assigns from any and all liability, claims, or demands for accidental personal injury, sickness, or death, as well as property damage and expenses of any nature, which may be incurred by me and/or my child while involved in the C.H.O.I.C.E.S. Experience, including B.U.I.L.D. Mentoring Collective if applicable.

Transportation Acknowledgment & Responsibility *

I understand that The Image Initiative, Inc. does not provide transportation.
I acknowledge that it is my responsibility, as the parent/legal guardian, to ensure that my child has appropriate transportation arrangements to and from C.H.O.I.C.E.S. Experience sessions.
I acknowledge that The Image Initiative, Inc. assumes no responsibility or liability for transportation arrangements, delays, incidents, or supervision related to travel to and from the session location.

Indemnification Agreement *

I agree to hold harmless and indemnify The Image Initiative, Inc. for any liability sustained as a result of the negligent, willful, or intentional acts of my child, including any expenses, reasonable costs, and attorneys’ fees incurred.

Emergency Medical Authorization *

I authorize The Image Initiative, Inc. to consent to any necessary emergency medical treatment for my child during participation in the C.H.O.I.C.E.S. Experience. I understand that if medical treatment is provided to my child, I am fully liable for, and agree to pay, all costs and expenses incurred.

NOTE: A separate permission slip will be provided for any field trips, and parents/legal guardians and participants will be notified as far in advance as possible.

Code of Conduct *

I understand that participants must treat fellow participants, staff, volunteers, chaperones, and mentors with respect; may not engage in harassment, bullying, cyber-bullying, threats, violence, or unsafe behavior; may not possess alcohol, illegal drugs, weapons, or dangerous materials; must follow program policies and staff directions; must use cell phones only when permitted; and must avoid inappropriate public displays of affection or other inappropriate behavior.

Signatures

Parent/Legal Guardian Signature *

Clear Signature

Draw signature in the box.

Parent: Please Type Your Name *

Date Parent or Guardian Signed *

Student Commitment *

I understand that C.H.O.I.C.E.S. only works when we all show up. I will do my best to attend every session, and I will let a facilitator or my parent/guardian know ahead of time if I can’t make it. I have talked about this with my parent/guardian and I agree to attend all sessions.

Student Signature *

Clear Signature

Draw signature in the box.

Student: Please Type Your Name *

Date Student Signed *

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The C.H.O.I.C.E.S. Experience® and B.U.I.L.D. Mentoring CollectiveSM

Student Permission SLIP 2026–2027

Session Dates

Program Facilitators

Parent/Legal Guardian & Emergency Contact

Parental Permission & Acknowledgements

Permission to Participate

B.U.I.L.D. Mentoring Collective

Criteria for Participation

Attendance Expectation

Signatures

The C.H.O.I.C.E.S. Experience^® and B.U.I.L.D. Mentoring Collective^SM