Name *

First Name

Last Name

Rocker's Phone *

(###)

###

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Name *

First Name

Last Name

Phone *

(###)

###

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Are you a current member of Girls Rock? *

Anyone can utilize the Instrument Library! If you participated in any GRDSM programming this year, we consider you a member. Community partners are also welcome to utilize the library.

Yes

No

By checking the "I Agree" box, I hereby assume and shall bear the entire risk of loss, theft of, damage to or destruction of the borrowed equipment and, in the event of loss of the borrowed equipment, agree to pay the full list price value plus sales tax. *

We've thoroughly inspected all instruments before they're checked out, just to ensure that everything is in great shape for you. In the event of an accident, please get in touch with us immediately via email at PD@girlsrockdsm.org.

I Agree

What would you like to checkout? *

Amp

Bass

Drums

Guitar

Keyboard

Ukulele

Auxiliary Instruments: Cajon, Djembe, Shakers, etc.

Other