Kirkwood Community Afterschool Program

The Kershaw County Library is partnering with the Kirkwood Community as they provide an afterschool program for children in the area! Middle school students will be able to join a writing club, reading club, or both. By joining these clubs, tweens/teens will get a free journal or book in order to participate. The program is hosted at the Kirkwood Community Center, under supervision of Iman Drakeford, community leader. These clubs begin in November, and kids will need to be signed up to participate.
Please see the form below to sign your tween/teen up for these great groups!

Kirkwood Community Registration

Name of Child*
First Last
Age of Child*
Name of Parent/Caregiver*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
I wish for my child to sign up for:*
- Kirkwood Reader's Club
- Kirkwood Writer's Club
- Both Clubs
Consent*
I acknowledge that my child will be participating in an afterschool activity at the Kirkwood Community Center under the supervision of community volunteers. These events are intended to be both educational and fun, building a good will and a sense of community, while allowing youth the opportunity to be creative and expressive.
Consent*
I assume all risk associated with participation in this event including, but not limited to: falls, contact with other participants, eating/drinking light refreshments, all risks being known and appreciated to me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, myself, and anyone entitled to act on my behalf, waive and release Kirkwood Progressive Organization, Inc. and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participating, or my child/children participating in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.
Consent*
Please note that being on time and attending all sessions will contribute to the success of the program. Participants and program coordinator may expect mutual respect. It is possible a participant may be asked to leave if behaviors that impact the program's success are continually exhibited.
Signature*

By typing your name here, it counts as your electronic signature.
Date*