Diversity Dialogue Day – Student Registration for March 26


Please type out full name of school
email address of school contact / educator that asked you to submit this form
(Note that VCIC will do our best to meet all requests.)
  • I give permission for my child to participate in the virtual 2021 Diversity Dialogue Day (DDD) sponsored by the Virginia Center for Inclusive Communities from 10:00 am – 2:00 pm on March 26, I understand that DDD is a human relations program that deals with mature subject matters possibly including stereotypes, prejudice, communication, racism, sexism, religious bias, etc.
  • I understand that although the program sponsor has taken precautions to provide proper organization, supervision, and instruction for each activity, it is impossible for the sponsor to guarantee absolute safety. I also understand that each participant shares the responsibility for safety during all activities and I assume that responsibility for my child. I waive any claim that may arise against the Board of Directors of the sponsor, and/or its employees, agents, volunteers, or lessors including those claims which may arise from the negligence of the sponsor, their Board of Directors; and/or its employees, agents, lessors or volunteers.
  • I understand that student participants are asked to complete an online evaluation that assesses their views on human relations issues and the DDD program. I give permission for my child to complete such forms.
  • I give permission for my child to be photographed or videoed by sponsors and/or others approved by sponsors at Diversity Dialogue Day.
Sign on the line with mouse cursor or with your finger on a touchscreen.
Signature is required.

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