Academy of Beloved Community – Registration Form

Please enable JavaScript in your browser to complete this form.

Registration Deadline: June 22, 2026 — Spaces are limited. Register today!

Form can be emailed: alcoablountnaacp@gmail.com
Website: alcoablountnaacp.org
Mail: 401 W. Broadway, Maryville, TN 37801

Full Name *

First

Last

Date of Birth *

Current Grade *

School *

Parent/Guardian Full Name *

First

Last

Relationship to Child *

Current Phone CHILD’S

Primary Phone No *

Alternate No

Email *

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact Full Name *

First

Last

Emergency Contact Phone No. *

Does your child have any known allergies/Health Needs? *

If yes, please describe allergies/Health Needs

Permissions and Agreements *

I give permission for my child to participate in all Academy of Beloved Community activities including cultural arts, African American history, group discussions, etc.
Photo/Video Release: I give permission for photos and/or videos of my child to be used for the Academy of the Beloved Community promotional materials and social media.
I understand that in the case of a medical emergency, every effort will be made to contact me. If I cannot be reached, I authorize emergency medical treatment for my child.
I confirm that all information provided in this registration form is accurate and complete.

Date *

Membership meetings are held on the fourth Saturday of each month at 11:30

Venue: St. Paul AME Zion Church, 401 W Broadway, Maryville, TN 37801

Useful Links

P.O. Box 6347, Maryville, TN 37802-6347

Email: alcoablountnaacp@gmail.com