"Still In The City - Part 2!" Reservation Form
Event Address: Elizabeth Baptist Church, 6114 Francis Avenue, Cleveland, Ohio  44127 
Contact us at (216) 369 - 9145 or nature@organicconnects.org
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Thursday, November 3, 2022
6:00 PM - 8:00 PM
Elizabeth Baptist Church, 6114 Francis Avenue, Cleveland, Ohio  44127 
What are the names and ages of people attending? *
Your Phone Number (please include area code)
Your Email Address
How did you hear about this event?
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TERMS & CONDITIONS: I, the Parent/Guardian of the above identified participant, do hereby release and discharge Burten, Bell, Carr Development, Inc., Slavic Village Development Corporation, Urban Farm Doctors, Deep Dive Art Project, Elizabeth Baptist Church, Organic Connects, Inc., partners, funders, sponsors, members, administrators, and agents (collectively known as the "Promoters") from any and all claims, present and future, known and unknown, due to, or arising in any manner from me or my child’s participation in the project or related activities sponsored by the Promoters. I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that me or my child and I may be exposed to or infected by COVID-19 by participating in this program and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of the program promoters and facilitators, including, but not limited to  the Promoters, employees, volunteers, program participants, and their families. I willingly agree and give my consent to let the Promoters enter data about my child and me into its computer information system. I hereby grant the Promoters and others acting on its behalf, the right to record  me and my child and our voice using audio, photographic, video, or other such techniques; to include my me and/or my child’s name, likeness, voice and biographical material in connection with these recordings; to use, reproduce, distribute, and exhibit such recordings in any and all media throughout the world without limitation; and to authorize others to do so, for any purpose which the Promoters and those acting pursuant to its authority deem appropriate. I hereby waive all rights of any nature in such recording(s) and the exhibition thereof. In case of an emergency, consent is granted to the Promoters staff to provide medical services through the appropriate medical facilities and/or medical service providers to  me or my child. *
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