Summer Arts Institute Application
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Student First Name
Student Last Name
Date of Birth
00/00/0000
Grade Completed June 2018
School Attended
District
Home Address
City
State
Zip Code
Home Phone
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.
If you cannot receive communication via email, please indicate how we can best reach you.
Parent/Guardian Name
Daytime Phone Number
Parent/Guardian Name
Daytime Phone Number
Participating in Optional Extended Day
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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)
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.
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Student Name
Family Physician Name
Phone
Office Address
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
Address
Phone
Relationship to Student
Please list anything in your child's health history, including allergies, which should be known.
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
ID or Contract Number
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)
What are your one or two favorite films?
Have you ever worked on a Mac?
Have you worked with film editing software (iMovie, Final Cut Pro, Avid)?
Section B
Please complete this section for Theatre Camp only
Have you had any previous theatre experience?
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If yes, please describe
Section C
 Please complete this section for Vocal Jazz Camp only
Do you have any previous vocal experience?
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If yes, please describe
Voice Part
Please check all that you are able to sing
Which do you prefer
Have you ever taken private voice lessons?
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Can you read music?
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Do you play any instruments?
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If yes, what instruments?
Do you have any vocal jazz experience?
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If yes, please describe:
Are you in your school chorus?
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Are you in any school select vocal groups?
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If yes, which ones?
Have you participated in:
Check all that apply
Do you have a song that is performance ready?
Clear selection
If yes, what is the title?
Name of your school music teacher
Section D
 Please complete this section for Musical Theatre Camp only
Do you have any previous vocal experience?
Clear selection
If yes, please describe
Voice Part
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Have you ever taken private voice lessons?
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Can You Read Music?
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Do you have a performance piece ready?
Clear selection
If yes, please list title
Do you have any previous acting experience?
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If yes, please describe
Section E
Please complete this section for Strings Camp only
Instrument
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How long have you been playing this instrument?
Was your instruction
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With whom have you studied
How long have you been reading music?
Have you been Suzuki trained?
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Do you have a polished piece for recital consideration?
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If yes, please list title and composer
Section F
Please complete this section for the Creative Writing camp only
What do you like to write?
What do you like to read?
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