Summer Academy Artist Registry
Register your artist ages 6-12 for our 2nd Annual Summer Arts Academy in Clarksville, TN. We look forward to teaching your artist acting, dance, musical theatre and exploring their great creativity. Registration should take approximately 15 minutes. 

Please be advised that payments are made via PayPal after registration. You will receive an invoice within 48 hours to the email you provide below. We look forward to creating with your young artists. 
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Artist Name *
Age/Upcoming Grade (example: 8/3rd) *
Shirt Size *
Special Skills and/or Interests; Please share anything you'd like to include about your artist.
Special Needs and/or Health Information *
 Parent/Guardian Name *
 Parent/Guardian Phone Number *
 Parent/Guardian Email *
Tuition Agreement

I, the parent/guardian of the registered child, agree to pay the Summer Arts Academy tuition within 24 hours of receiving a tuition invoice to email provided above. 

Tuition fee: $75.00/1st Artist (20% off additional artists: $60.00)
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Required
Emergency Contact Information *
Please list your primary emergency contact using their full name, phone number and relation.
Persons other than the parent/guardian and emergency contact who are authorized to receive the child at pick up or in the case of an emergency. Please list a minimum of two people. Include contact information for each. *

In consideration of my registration and permitting my child to participate in this activity, I hereby:

WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the Southern Black Arts Council, its trustees, officers, employees, camp counselors, volunteers, entities or other persons released, for my child’s death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to them including their traveling to and from this activity;

INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE Southern Black Arts Council, its trustees, officers, employees, volunteers, or other entities or persons released from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise.

I understand that while participating in this activity, my child may be photographed. I agree to allow their photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns.

The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. Southern Black Arts Council, its Trustees, directors, officers, and all its employees, acting officially or otherwise are hereby released from any and all claims, demands, actions, or causes of action on account of any injury to my child that may occur. This release binds my heirs, executors, administrators, and/or assigns.

I CERTIFY THAT I HAVE READ THIS DOCUMENT, FULLY UNDERSTAND ITS CONTENT, AND AGREE TO ITS TERMS.

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Required
Are you registering another artist? *
List the additional artists to receive your tuition discount. The discount applies only to siblings. *
List your additional children, their age, shirt sizes, interests and special needs in this section. Use one line per child.
Will your artist(s) be performing in the finale on June 17, 2023 at the 3rd Annual Juneteenth Block Party? *
Campers will be an integral part of the opening performance as well as the young artist showcase. 
Is the parent or guardian willing to volunteer on June 17th, 2023 for 30 or 60 minutes? *
Southern Black Arts serving the community in various areas throughout the day. We need your help for a smooth flow of the day. Volunteers will not be scheduled during their child's performance time(s). Tasks and responsibilities will include setup, breakdown, hydration station, art walk monitor, artist escort, flyer ambassador and booth ambassador.
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