Queendom 101 Application 2021
Queendom 101 is a 501 (c)(3) that exists to prepare our young women for the future through mentorship, cultivating life skills, social-emotional growth, exposure to empowering experiences and strengthening lasting relationships. Queendom 101 provides opportunities for young women to improve in various aspects of their lives and empower others. Queendom 101 focuses on empowering young women to make the world around us a better place! We are honored to invite you to Queendom 101 an organization that places emphasis on empowering young women for the future. We are seeking young queens to help guide through the importance of money, self-love, manners, safety, positive self-esteem, and more throughout the year ahead. If interested please review the requirements, review the application, and complete the online application below.
Additionally, I hereby grant permission to the rights of my image, likeness, and sound of my voice as recorded on audio or videotape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published, or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.
Photographic, audio or video recordings may be used for the following purposes:
• conference presentations
• educational presentations or courses
• informational presentations
• online educational courses
• educational videos
By completing and submitting this application I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in the public educational setting. I will be consulted about the use of the photographs or video recording for any purpose other than those listed above. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed. This release applies to photographic, audio or video recordings collected as part of the Queendom 101 Club, program, sessions or events.
By completing and submitting this application I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.
If you have any questions contact Christina Hull (New Orleans,LA) or Ebony Lewis (Baker,LA) via email:
• Eligible participants must live in metro NEW ORLEANS, LA or BAKER, LA or surrounding areas
• Be 8-18 years old
• Currently enrolled in an accredited school at the time of submission
• Submit completed online application
• Commit to attending one event a month (if an event is scheduled)
Christina Hull, M.Ed
Ebony Lewis, M.A.
Date of Birth
School Name and Grade Level
Parent/Guardian Phone Number
Emergency Contact Name & Phone Number
Food Allergies and/or Specifications
Medical Alerts (Ex: Sickle Cell Anemia/Seizures/Other)
T-shirt Size (Fitted T-Shirt)
Send me a copy of my responses.
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