BOOMSHAKE PARTICIPANT ENROLLMENT FORM

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Thank you for your participation in BoomShake. There are 4 sections to this enrollment form. The first and fourth section are required and the other sections optional. Please complete or as little or as much as you like. We would love to get as much information from you to help us continue to build a supportive and progressive community.

Section 1- Participant Information
Section 2- Get Involved (if you have skills that you want to contribute to BoomShake, please let us know)
Section 3- Your Music & Culture (share with us about you/your family to help build a more culturally relevant program)
Section 4- Participant Waiver & Disclaimers

Thank you!!

Participant Full Name *

Include your full name and also your preferred name(s) in [__________ ]

Phone # *

Email *

Gender Pronouns *

Ethnicity *

Are you a person of color? *

Yes

BoomShake classes/activity you are enrolling in? *

(check all that apply)

Spring 2017 Session ONE: Monday Women/Trans 7-9PM at The Flight Deck

Spring 2017 Session ONE: Tuesday Performance Core (Invitation-Only) at The Flight Deck

Spring 2017 Session TWO: Monday Women/Trans 7-9PM at The Flight Deck

Spring 2017 Session TWO: Tuesday (Invitation-Only) at The Flight Deck

Summer Session 2017: Tues 8-10pm at the Flight Deck

Manzanita SEED Elementary [Parent/Guardian]

Manzanita SEED Elementary [Child]

Tyke Tunes @ Rice and Beans

Other:

Required

How did you hear about the BoomShake class/ event? *

Why did you decide to participate? *

What are you looking forward to experiencing/learning/discovering/exploring this session? *

Skills, Goals and Vision

What specific skills do you hope to develop/strengthen this session? What are your personal goals for the class? What are your ideal visions for the community and what would you like your role to be?

How do you Boom & Shake?

What tools work best for you to remember and practice new skills? Improve? Do you want feedback from the facilitators about your playing? What is the best way to give you feedback?

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