Save Rochester's 2nd Annual Juneteenth Teen Poetry Slam

Juneteenth Teen Poetry Slam Event Registration

Thank you for your interest in competing in Save Rochester's 2nd Annual Juneteenth Teen Poetry Slam. Please fill out this short survey to complete your registration.

2nd Annual Juneteenth Poetry Slam

Highland Bowl

South Avenue

June 19th, 2021 at 6pm

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* 1. Will you be at least 12 years of age and no older than 18 years of age on June 19th, 2021?

Yes

Not at this time, but keep me in mind for future events

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* 2. Date of Birth

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* 3. Do you or will you have an original piece, not copied or plagiarized from any other source, to perform for the competition?

Yes

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* 4. Your poem MUST relate to Black History, Juneteenth, or any other Black Lives Matter issue. Will you perform an original poem pertaining to one or more of these issues?

Yes

Not sure

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* 5. How would you like to receive additional information about Save Rochester's 2nd Annual Juneteenth Teen Poetry Slam?

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Both

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* 6. First and Last Name

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* 7. Your Email Address

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* 8. Your Phone Number

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* 9. Parent or Guardian Phone Number

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* 10. There is a one time $5.00 registration fee to ensure your commitment and participation in our program. Someone will be reaching out to you for instructions on how to pay your registration fee. The registration fee is non-refundable. Do you understand that you will not be registered for the competition until your registration fee is paid and should you not attend the event you will forfeit your registration fee?

Yes