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2012 Juilliard Jazz Camp (So. Florida) Application
2012 Juilliard Jazz Camp (So. Florida) Application
JAZZ
Summer 2012
Camps and Workshops
West Palm Beach
Bak Middle School of the Arts
1725 Echo Lake Drive, West Palm Beach, FL 33407
In partnership with
Juilliard
JAZZ
Summer 2012
Camps and Workshops
Instruments for the Juilliard Summer Jazz Residency in West Palm Beach:
Trumpet, Saxophone, Trombone, Guitar, Piano, Double Bass,
Electric Bass, and Drums.
Please note:
Guitar, Double Bass, and Electric Bass students are required to bring their
own amp and pick-up cables to all rehearsals and performances.
There is no vocal program.
Juilliard JAZZ
Summer 2012 Camps and Workshops West Palm Beach, FL June 11-15 June 18-22
Program Schedule
Sample Days
Day 1:
9:00am 12:00pm Placement Exams
During the placement exams,
Juilliard students will supervise
activities for the campers.
12:00pm
1:00pm
2:00pm
3:00pm
4:15pm
5:00pm
Lunch
Small Ensembles/Combo
Listening Sessions
Large Ensembles
Jam Session
Dismissal
Day 2-4:
9:00am
10:00am
11:00am
12:00pm
1:00pm
2:00pm
3:00pm
4:15pm
5:00pm
Musicianship
Individual Practice
Small Ensembles/Combo
Lunch
Small Ensembles/Combo
Listening Sessions
Large Ensembles
Jam Session
Dismissal
Day 5:
9:00am 11:00am Ensemble Rehearsal
11:00am 1:00pm Dress Rehearsal
1:00pm 2:30pm Lunch/Break
2:30pm Concert Run-Through
4:00pm Dinner
6:00pm Concert
Music Requirements for Juilliard Summer Jazz Residencies in West Palm Beach
Each camp will begin with placement into ensembles. Students should be prepared to:
Play C Jam Blues by Duke Ellington
Advanced students may choose a jazz standard from the list below:
Blue Bossa
Autumn Leaves
Stella by Starlight
Nows The Time
Students may be asked to play 1 major and/or1 minor scale (2 octaves)
Location
All classes and concerts for the Juilliard Summer Jazz Residencies will take place at Bak Middle School of the Arts,
1725 Echo Lake Drive, West Palm Beach, FL 33407. Students and parents are expected to make their own
transportation arrangements; no bus service will be provided. Students are expected to bring lunch and snacks daily.
Program structure may be adjusted according to enrollment. No housing is provided.
Please contact Ms. Rebekah Gilbert at (212) 799-5000 ext. 7380 if the student has special needs or requires a
reasonable accommodation.
Admissions
The Juilliard Summer Jazz Residencies will take place June 11-15 (Grades 6-8) and June 18-22 (Grades 9-12), 2012.
Applicants should complete the attached application; the application deadline is May 2, 2012.
A completed application includes the application form and a $150 non-refundable, non-transferable tuition deposit
(check or money order made payable to the Middle School of the Arts Foundation).
Application Timeline
Juilliard JAZZ
June 18-22
Middle
Last
Apt Number
_______________________________________________________________________________________________________________________________
City
State
Zip Code
_______________________________________________________________________________________________________________________________
Home Phone Number
Male Female
E-mail Address
MM/DD/YY
T-Shirt Size: XS S M L XL
How did you receive the brochure and application form? (Please be specific) ______________________________________________________________
INSTRUMENT (circle one):
trumpet
tenor saxophone
alto saxophone
baritone saxophone
trombone
drums
double bass
electric bass
guitar
piano
Yes
Mother
Father
Both
Other: __________________________________________________________
Middle
Last
Apt Number
_______________________________________________________________________________________________________________________________
City
State
Zip Code
_______________________________________________________________________________________________________________________________
Home Phone Number
_______________________________________________________________________________________________________________________________
E-mail Address (1)
Middle
Last
Apt Number
_______________________________________________________________________________________________________________________________
City
State
Zip Code
_______________________________________________________________________________________________________________________________
Home Phone Number
_______________________________________________________________________________________________________________________________
E-mail Address (1)
I certify that the information offered in this application is true and complete.
Parent/Guardian Signature: __________________________________________________________________________ Date:___________________________
Mail application and $150 non-refundable/non-transferable tuition deposit (check or money order made payable to Middle School of the
Arts Foundation) to: Mr. Cleve Maloon, Bak Middle School of the Arts, 1725 Echo Lake Drive, West Palm Beach, FL 33407 (561) 882-3892
Juilliard JAZZ
June 18-22
Middle
Last
Address: _______________________________________________________________________________________________________________________
Street Address
Apt Number
_______________________________________________________________________________________________________________________________
City
State
Zip Code
_______________________________________________________________________________________________________________________________
Home Phone Number
Parent/guardian
Name: ___________________________________________________________________________________________________________________________
First
Middle
Last
Street Address
Apt Number
_______________________________________________________________________________________________________________________________
City
State
Zip Code
Second parent/guardian
Name: ___________________________________________________________________________________________________________________________
First
Middle
Last
Street Address
Apt Number
_______________________________________________________________________________________________________________________________
City
State
Zip Code
Work Phone
In the event a child needs to see a physician, the School District of Palm Beach County cannot be responsible for transportation to and from the doctor. The custodial parent or
guardian will be notified to come and transport the child, or in the case of an emergency, the child will be transported by EMT services. In this document, School District of Palm
Beach County means the sponsor of the activities in which the registrant engages in the school known as Bak Middle School of the Arts. Also in this document, school property
refers to instruments and equipment owned by School District of Palm Beach County or The Juilliard School.
Permission to Provide Necessary Treatment or Emergency Care: I hereby give permission to the medical personnel to order X-rays, routine tests, and treatment, to release any
records necessary for insurance purposes, and to provide or arrange necessary related transportation, for me or my child. In the event my child experiences a medical emergency,
and residency personnel try but fail to reach me or under the circumstances are without sufficient time to try to reach me, I hereby give permission to the physician or other medical
personnel to secure and administer treatment, including hospitalization, anesthesia, surgery, and injections of medication for my child. As long as the medical treatment considered
necessary in the situation is in accordance with generally accepted standards of medical practice for the particular type of injury or illness involved, I impose no specific limitations or
prohibitions regarding treatment other than the following: ________________________________________________________________________________________________
Juilliard JAZZ
Summer 2012 Camps and Workshops West Palm Beach, FL
Insurance Information
Is the participant covered by family medical/hospital insurance? _________________________________________________________________________
Indicate carrier or plan name _____________________________________________________ Group # _________________________________________
Name of insured _____________________________________________________ Relationship to residency participant ____________________________
Social security number of policy holder or insurance ID number _________________________________________________________________________
Please submit a copy front and back of your health insurance card.
Does your child have a Behavior Intervention Plan (BIP) at his/her school?
Yes
No
Does your child take medication for behavior issues during the school year?
Yes
No
If yes, will he/she be taking this medication at the residency? If yes, please explain below.
Yes
No
Yes
No
Penicillin
Drugs
Insect Bites
Asthma
Food
Other
PLEASE NOTE: Any accidents and illnesses must be reported to School District of Palm Beach County/Juilliard staff before the participant leaves the
school each day. The residency participant is not allowed to possess any type of medicine on school grounds unless he or she has a letter of
explanation.
Please note the medication must be in the original prescription container/bottle with the name and an explanation note from the prescribing physician.
Over the counter medication should be brought in the original container with a parent note of explanation. All explanation notes and medicines should
remain with the residency participant at all times. The School District of Palm Beach County and Juilliard are not responsible for monitoring and
dispensing medication.
PARENT/GUARDIAN AUTHORIZATION: The residency participant described has permission to engage in all residency activities except as noted by
me in a separate letter (to be submitted with application). The residency participant and his/her parent/guardian agree to abide by the rules and
regulations set up by the School District of Palm Beach County for health, safety and welfare of the residency. The following violations of residency
rules will result in immediate dismissal without refund of fees:
1) Leaving Bak Middle School of the Arts without permission.
2) Willful destruction of school property.
3) Use of drugs and/or alcoholic beverages.
4) Fighting and/or continued insubordinate behavior resulting in disrupting of the residency program.
Juilliard JAZZ
Summer 2012 Camps and Workshops West Palm Beach, FL
Consent Form
Residency (check one) June 11-15
June 18-22
CONSENT FORM
All scheduled activities (both on & off campus) are closely supervised. Please check yes or no for each statement, and sign at bottom of page.
I give permission for my childs name, picture, or video clips taken of my son/daughter to be used in School District of Palm Beach
County/Juilliard publicity or publications.
Yes
No
I understand that I am responsible and financially liable for the medical care of my child. In case of an emergency and I cannot be
notified, the school has permission to seek medical attention for my child.
Yes
No
I agree that I will not hold the School District of Palm Beach County and The Juilliard School responsible for any accidents, injuries or
other harm occurring to my child during the residency.
Yes
No
Notary Seal