Rock Block NPL Registration FormPlease complete this form to register your youth in the YEAH! Rock Block NPL Program. Participant Information Full Name * First Name Last Name Age * Grade * Pronouns * (she/her, he/him, they/them, etc) Contact Information Parent/Guardian Name * First Name Last Name Parent/Guardian Email * Parent/Guardian Phone Number * (###) ### #### Emergency Contact Name & Phone Number * Location & Time Selection Select Your NPL Branch Location: * Thompson Lane Bordeaux Edgehill Choose a Time Slot: * Thompson Lane: Saturdays 1:00-2:00 PM with Daena Thompson Lane: Saturdays 2:00-3:00 PM with Daena Bordeaux Edgehill Music Background Have you participated in a YEAH! program before? * Yes No Do you already play an instrument? * Yes No Access & Accommodations Please list any accessibility accommodations needed here: Instrument Responsibility Acknowledgment * I understand each student will be responsible for obtaining their own instrument for at-home practice. I acknowledge that youth under 18 will need a parent or guardian to help check out an instrument from NPL’s Library of Things. Permissions & Agreements * I give permission for my child to participate in Rock Block NPL. I give permission for YEAH! and Nashville Public Library to take and use photos/videos of my child for program documentation and promotion. * I agree to receive email updates and important information related to this program. Thank you!
