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BOOMSHAKE PARTICIPANT ENROLLMENT FORM
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 [__________ ]
Your answer
Phone #
Your answer
Email
Your answer
Gender Pronouns
Your answer
Ethnicity
Your answer
Are you a person of color?
BoomShake classes/activity you are enrolling in?
(check all that apply)
Required
How did you hear about the BoomShake class/ event?
Your answer
Why did you decide to participate?
Your answer
What are you looking forward to experiencing/learning/discovering/exploring this session?
Your answer
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?
Your answer
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?
Your answer
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