Girls Rock! RI Adult Group Lessons Fall 2017 Registration Form
Hello!

This registration form is for Adult Group Music Lessons with Girls Rock! Rhode Island. Please fill out this form to get on board. Participants must be 18+ years old. We welcome girls, women, trans, and gender non-conforming individuals in our programming.

All lessons will be held at our program space at 769 Westminster Street on the West Side of Providence. Lessons will start the first week of October and run for 10 weeks, culminating in a community concert on Saturday, December 16th.

Mondays 6:30-7:30pm /// Intro to Vocals with Emily Goldstein
Tuesdays 6:00-7:00pm /// Intro to Bass Guitar with Ash Russell
Wednesdays 6:30-7:30pm /// Beginner/Intermediate Guitar with Karen Orsi
Thursdays 6:00-7:00pm /// Intro to Keyboards with Khym Carmichael
Sundays 1:30-2:45pm /// Beginner Drums with Rachel Blumberg
Sundays 3:00-4:15pm /// Intermediate Drums with Rachel Blumberg

More info and class descriptions here: http://girlsrockri.org/register-grouplessons/

Don't forget to click "submit" at the end of the form to complete your registration! We will follow up with you about payment and financial aid requests.

Thanks!
Girls Rock! RI

Participant Info!
First Name
Your answer
Last Name
Your answer
Name you prefer to be called by instructors
If different than above
Your answer
What gender pronouns do you use? (optional)
i.e. she/her/hers, they/them/theirs, he/him/his, etc. We ask only so that we have a sense of how you would like us to refer to you.
Your answer
Street Address
Where you receive mail
Your answer
Apartment/unit/floor #
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Email Address
We use email as our main mode of communication so please submit an email address that you check frequently
Your answer
Phone number(s)
Cell
Your answer
Home
Your answer
Work
Your answer
What is the best way to contact you?
Emergency Contact
First and last name
Your answer
Relationship to you
Your answer
Phone number
Your answer
About Music and More!
What class would you like to attend?
(If you want to take more than one class, please fill out a separate form for each class)
How long have you played this instrument?
Playing/practicing regularly
What is your level of experience with this instrument?
If you have played this instrument before, how did you learn to play it?
Select all that apply
Required
Have you attended Girls Rock! Rhode Island's Ladies Rock Camp before? If so, when?
Select all years attended
Required
If you have attended Ladies Rock Camp before, what instrument did you play in your band?
Select all that apply
Who are 3-5 of your favorite bands/artists?
Your answer
How did you hear about Girls Rock! RI's Group Lessons?
Your answer
If we offered other instruments through our group music lessons, what else would you like to learn?
Your answer
More About You!
Demographics, medical issues, etc.
Racial/ethnic identity (optional)
Creating a group of participants that reflects the diversity of Rhode Island is a priority for our programming. In addition, some of our funders require the racial/ethnic and economic make-up of our program population to be documented. Providing the following information will help us meet our diversity goals and help us continue to receive funding for future sessions. Check any that apply.
Age
Must be 18 or older to participate in Adult Group Lessons (if you are under 18 years old you can sign up for Youth Group Lessons!). This also helps us provide information to funders
Your answer
Date of birth
This helps us provide information to funders
MM
/
DD
/
YYYY
Language needs
Do you have difficulty understanding lessons in English? If you are in need of language interpretation, we will do our best to accommodate. Please indicate your first language here:
Your answer
Medical conditions/allergies/dietary restrictions
Do you have any medical conditions, mental health issues, allergies, dietary restrictions, or other issues that the staff should know about? All medical information will be kept confidential and shared only with necessary staff.
Your answer
Current Employer(s)
or other organizations/institutions you're affiliated with
Your answer
Current Job Title(s)
or other ways you spend your time
Your answer
Do you have friends or relatives who are also attending Group Lessons?
If so, please list their name(s) below:
Your answer
Gear Loan!
You will need to have a guitar or ukulele to bring to lessons and practice at home. Drums will be provided by Girls Rock! RI to use during lessons, but you will also need something at home to practice on. If you do not have your own instrument, you can borrow a guitar, bass, keyboard, amp or drums through our Gear Loan Program (pending availability). There is a small deposit required, which will get refunded when you return the instrument.

No instrument is needed for vocal lessons - your voice is your instrument! Please select "No" if you are signing up for the vocals class.

Are you interested in borrowing an instrument during Group Lessons?
Payment and Financial Aid
Tuition for the Fall Session of Group Lessons is
---$250 for the vocal, bass, guitar, or keyboard class
---$280 for the drum classes

We have need-based financial aid available to offset the cost for those who are unable to pay full tuition.

If you would like to request a full or partial scholarship to offset the cost, please indicate here and fill out the following section. If you are interested in receiving financial aid but are unsure if you qualify, please go ahead and complete this section. We will follow up with you to confirm whether we can provide a scholarship for you.

Would you like to apply for financial aid?
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