Event Four

Sunday, February 18, 2024
12:00 PM 1:00 PM

The Berlin 606 Washington Street Clarksville, TN, 37040 United States (map)

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Come celebrate past and present African American poets during the free youth poetry/spoken word workshop!

Attendees will learn about Black poetic themes, styles and techniques with artist and poet, I.AM.HER.LADYFLAME. Ages 9-14

Youth Name

First Name

Last Name

Phone

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Youth Age

Waiver and Release:

I hereby waive and release Black Clarksville, its officers, agents and employees, from and against any claims, suits, losses, or related causes of action for damages, including attorney’s fees and court costs, that may result from injury or death, accidental or otherwise, during, or arising from my child’s participation in a recreation program, and any resulting illness and/or injury, and I agree to indemnify and hold harmless the Black Clarksville from and against any and all such claims. I recognize that the recreational events or activities being entered into by my child can be dangerous to my child and I accept those dangers. I understand that if my child is injured, this waiver will be used against me and anyone else claiming damage in any legal action because of my child’s injury. I hereby acknowledge that I understand and am familiar with the nature of the activities in which my child will participate at this facility, and affirm that my child is in good health and that my child does not have a physical or emotional condition, past or present, of which I am aware, which would in any way affect my child’s ability to participate in recreation programs. I also understand that I should have health and accident insurance to cover injuries arising from participation in recreation programs. I also understand that I am responsible for immediate pick-up of my child upon completion of the program the child was registered in. In case of emergency, I give my permission for emergency medical treatment of my child and for transportation to such treatment. Photo/Video Consent: Photographs/videos may be taken during various programs. These photographs/videos may be used for future Black Clarksville promotional material

I Agree

February 17

Event Five

February 25

Event Three

Black Clarksville

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