Summer Arts Institute Application
Student First Name
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Student Last Name
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Date of Birth
00/00/0000
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Grade Completed June 2019
School Attended
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District
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Home Address
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City
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State
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Zip Code
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Home Phone
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Email Address
Email will be used for follow up communication. For efficiency and environmental resources, we plan to send further information via email; if this is not a good method of communication for you, please let us know.
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If you cannot receive communication via email, please indicate how we can best reach you.
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Parent/Guardian Name
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Daytime Phone Number
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Parent/Guardian Name
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Daytime Phone Number
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Participating in Optional Extended Day
Camp(s) Applying For
Please indicate t-shirt size (adult sizes)
Publicity Permission I understand that photographic images of my child may be taken during workshops, rehearsals, or productions. I give the Summer Arts Institute permission to use photographs of my child in future publicity, including online advertising and Facebook. *
Date
MM
/
DD
/
YYYY
Disability Accommodation (please indicate any requirements)
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Authorization of Medical Treatment of Minors
I, the parent of legal guardian of (enter student name below) do hereby give permission for emergency medical treatment to be administered to the minor listed below in the event that an emergency has occurred and I cannot be reached at the numbers listed above.
Student Name
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Family Physician Name
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Phone
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Office Address
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Emergency Contact
Please give name, address and telephone number of a person to whom we can release the student in case of emergency if you cannot be reached
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Address
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Phone
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Relationship to Student
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Please list anything in your child's health history, including allergies, which should be known.
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Insurance Company/Government Program
The Summer Arts Institute does not carry insurance to pay for treatment of any injuries to children participating in its summer programs. It is understood that the parent(s)/guardian(s) have health insurance for the student or have the means to pay for necessary medical treatment
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ID or Contract Number
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Section A
Please complete this section for Film Camp only
What kinds of movies do you watch and like best (e.g.: action-adventure, comedy, drama, biography, documentary)
Your answer
What are your one or two favorite films?
Your answer
Have you ever worked on a Mac?
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Have you worked with film editing software (iMovie, Final Cut Pro, Avid)?
Your answer
Section B
Please complete this section for Theatre Camp only
Have you had any previous theatre experience?
If yes, please describe
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Section C
Please complete this section for Vocal Jazz Camp only
Do you have any previous vocal experience?
If yes, please describe
Your answer
Voice Part
Please check all that you are able to sing
Which do you prefer
Your answer
Have you ever taken private voice lessons?
Can you read music?
Do you play any instruments?
If yes, what instruments?
Your answer
Do you have any vocal jazz experience?
If yes, please describe:
Your answer
Are you in your school chorus?
Are you in any school select vocal groups?
If yes, which ones?
Your answer
Have you participated in:
Check all that apply
Do you have a song that is performance ready?
If yes, what is the title?
Your answer
Name of your school music teacher
Your answer
Section D
Please complete this section for Musical Theatre Camp only
Do you have any previous vocal experience?
If yes, please describe
Your answer
Voice Part
Have you ever taken private voice lessons?
Can You Read Music?
Do you have a performance piece ready?
If yes, please list title
Your answer
Do you have any previous acting experience?
If yes, please describe
Your answer
Section E
Please complete this section for Strings Camp only
Instrument
How long have you been playing this instrument?
Your answer
Was your instruction
With whom have you studied
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How long have you been reading music?
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Have you been Suzuki trained?
Do you have a polished piece for recital consideration?
If yes, please list title and composer
Your answer
Section F
Please complete this section for the Creative Writing camp only
What do you like to write?
Your answer
What do you like to read?
Your answer
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