Carrying Our History Forms – Fahrenheit Creative Group, LLC

ABOUT THE PROGRAM

The Carrying Our History Youth Project is a five-month oral history and storytelling program running from April through August 2026. Approximately 12 public high school students from Sunflower County will document the civil rights history of the Mississippi Delta through oral history interviews, peer learning circles, and multimedia storytelling, culminating in a community presentation in August 2026.

The program is a collaboration between Fahrenheit Creative Group (FCG), W.K. Kellogg Foundation (WKKF), Sunflower County Consolidated School District (SCCSD), Mississippi Humanities Council (MHC), and community partners, as part of the COMMON GOOD Delta initiative.

Meetings are held bi-weekly at SCCSD facilities. FCG will provide transportation assistance to help students travel to and from approved program activities, including field trips and community site visits.

Program Permission Form

Section1: Student Information

Student's Full Name(Required)

First Last

Date of Birth(Required)

Grade(Required)

School(Required)

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone (if applicable)

Student's Email Address (if applicable)

Section 2: Parent/Guardian Information

Parent/Guardian Name(Required)

First Last

Relationship to Student(Required)

Primary Phone (Cell/Home)(Required)

Secondary Phone (Work/Home)(Required)

Email Address(Required)

Mailing Address (if different from student's)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Emergency Contact (if different from parent/guardian listed above)

First Last

Relationship to Student

Phone

Section 3: Attendance Commitment

The Carrying Our History Youth Project runs from April through August 2026. Program meetings are held bi-weekly throughout the program period, with advance notice provided to students and families. Students are expected to attend a minimum of 50% of all scheduled program meetings and activities in order to remain in good standing and receive their full stipend. By completing this form, the parent or guardian agrees to support their student’s attendance and to notify the program coordinator as early as possible when a conflict arises.

50%(Required)

I understand and agree that my student is expected to attend a minimum of 50% of all scheduled program meetings and activities.

I agree to communicate promptly with the program coordinator regarding any conflicts or absences.

Section 4: Transportation Consent

Program meetings will be held at Sunflower County Consolidated School District facilities. For approved field trips and community site visits outside of the school campus, FCG will coordinate and provide transportation. All transportation will be to and from program-approved locations only. By completing this form, you consent to your student traveling via FCG-coordinated transportation for the duration of the program. You will also be asked to complete a separate field trip permission form for each individual off-site activity.

Liability(Required)

I consent to my student traveling via FCG-coordinated transportation to and from approved program activities.

I understand that a separate field trip permission form will be required for each individual off-site activity.

Section 5: Participation and Liability

Participation in the Carrying Our History Youth Project involves in-person meetings, community site visits, oral history fieldwork, and other program activities. While program staff will exercise reasonable care for student safety at all times, certain activities carry inherent risk. By completing this form, you acknowledge that your student will be participating in program activities and agree to release and hold harmless Fahrenheit Creative Group, LLC (FCG), W.K. Kellogg Foundation (WKKF), Sunflower County Consolidated School District (SCCSD), Mississippi Humanities Council (MHC), and their respective employees, agents, and representatives from any and all claims, damages, or liability arising out of or in connection with your student’s participation in the normal course of program activities, except in cases of gross negligence or willful misconduct.

Transportation(Required)

I understand that participation in program activities involves some inherent risk and agree to the terms described above.

I authorize program staff to seek emergency medical attention for my student if I cannot be reached and immediate care is required.

Parent/Guardian Acknowledgement and Signature

By signing below, I confirm that I have read and understand all sections of this form. I give my permission for the student named above to participate in the Carrying Our History Youth Project for the full program period of April through August 2026, subject to the terms described herein.

Parent/Guardian Signature(Required)

Name(Required)

Date

Student Acknowledgement and Signature

I have read or had this form explained to me. I understand what is expected of me as a participant in the Carrying Our History Youth Project and agree to honor these commitments.

Student Signature(Required)

Name(Required)

Date

Video and Photo Release Form (Student Participants)

I hereby confirm my agreement with Fahrenheit Creative Group, LLC (“FCG”), W.K. Kellogg Foundation (WKKF), Sunflower County Consolidated School District (SCCSD), Mississippi Humanities Council (MHC), We2gether Creating Change, Delta Health Center (DHC), Mississippi Center for Justice (MCJ), and their legal representatives, designees, assignees and successors regarding the disposition of all video documentary and photographs produced during the participant’s involvement in the Carrying Our History Youth Project.

I understand that video footage, photographs, and transcripts of any and all interviews produced during the participant’s involvement will be maintained and made available indefinitely by FCG, WKKF, SCCSD, and MHC for such research, production, and educational purposes related to the COMMON GOOD Delta project as the videographer, photographers, and/or FCG, WKKF, SCCSD, and MHC shall determine.

I hereby grant and transfer to FCG, WKKF, SCCSD, and MHC all rights, title, and interest in the video documentary and all related materials produced during the participant’s involvement, including, without limitation, the literary rights and the copyright. I hereby release FCG, WKKF, SCCSD, and MHC, and their legal representatives, designees, assignees, and successors from all claims and liability relating to said documentary and photographs.

FCG, WKKF, SCCSD, and MHC agree to retain the integrity of the participant's image and voice, neither misrepresenting the participant's words nor taking them out of context. I attest that I have voluntarily agreed to take part in this project and that this document contains the entire and complete agreement concerning the use and preservation of materials produced during my involvement. Furthermore, I understand that no royalty, fee, or other compensation shall become payable to me for the rights granted herein. Any stipend provided is compensation for program participation and is not consideration for the rights granted herein.

Student Participation Acknowledgment

I understand the purpose of the Carrying Our History Youth Project and agree to participate, including the recording, use, and preservation of my image, voice, and any materials I produced as described herein.

Student Signature(Required)

Name(Required)

First Last

Date(Required)

Parent/Guardian Consent

I am the parent or legal guardian of the student participant named above. I have read this release form and consent to my child’s participation in the Carrying Our History Youth Project, including the recording, use, and preservation of their image, voice, and any materials they produced as described herein.

Parent/Guardian Signature(Required)

Name(Required)

First Last

Date(Required)

Equipment Form

As part of participation in the Carrying Our History program, you will be issued recording equipment to support oral history interviews and related project activities. This equipment is essential to your learning and success during the program and must be handled with care and responsibility at all times.

By completing this form, I agree to the following:

Responsibility for Equipment: I accept full responsibility for all equipment assigned to them for the duration of the program.
Proper Use and Care: I agree to use the equipment only for its intended purpose and to handle it with the highest level of care. This includes properly setting up, monitoring, and storing the equipment, as well as protecting it from damage, loss, or theft.
Equipment Maintenance: I agree to maintain the condition of the equipment and return all items in the same condition in which they were received, aside from normal wear and tear.
Loss, Damage, or Theft: I understand that in the event that the equipment is lost, stolen, or damaged due to misuse or negligence, I and my parent/guardian agree that $77.50 (half of the total replacement cost) will be deducted from my program stipend.
Timely Reporting: I agree to promptly notify program staﬀ of any damage, malfunction, loss, or theft of equipment.

Student Name(Required)

First Last

Participant Signature(Required)

Date(Required)

Parent/Guardian Name

First Last

Parent/Guardian Signature(Required)

Signature(Required)

Date(Required)

Equipment Set(Required)

Field Trip Permission Form

Please complete and return this form to your student’s program coordinator prior to the scheduled trip date. Students will not be permitted to participate without a completed and signed form on file.
Trip Details
Destination: Jackson, Mississippi
Date of Trip: July 23, 2026
Departure Time: 7:30 am
Return Time: 7:00 pm
Transportation: Coordinated by Fahrennheit Creative Group

Section 1: Student Information

Name(Required)

First Last

School(Required)

Home Address

Street Address Address Line 2 City State ZIP Code

Section 2: Parent/Guardian and Emergency Contact Information

Name(Required)

First Last

Relationship to Student(Required)

Phone(Required)

Emergency Contact (if different from parent/guardian)

First Last

Relationship to Student

Phone

Section 3: Medical Information

Does the student have any known allergies?(Required)

Yes

Please describe any allergies.

Does your student carry an EpiPen or inhaler?(Required)

Yes

Current Medications

Are there any other medical conditions we should be aware of?

Section 4: Transportation Consent

Student transportation to and from field trip locations will be provided by Fahrenheit Creative Group (FCG). By signing this form, you consent to your student traveling by program-arranged transportation on the date listed above.(Required)

I consent to my student traveling via program-arranged transportation.

I do NOT consent to program-arranged transportation.

By signing below, I confirm that I have read and understand the information provided in this form. I grant permission for my student to participate in the field trip described above and acknowledge that program staff will exercise reasonable care for my student’s safety and well-being during the activity.

Date