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1 Juilliard JAZZ Summer 2013 Camp in Atlanta,GA June 17-21, 2013 One-week program for dedicated and disciplined students ages 12-18, who are passionate about jazz music For details see Juilliard s Web site: juilliard.edu/summerjazz In partnership with

2 Juilliard JAZZ Summer 2013 Camp in Atlanta, GA The Summer Jazz camp in Atlanta, GA is a one week program for students who are dedicated, disciplined, and passionate about jazz. Located at North Atlanta High School Center for the Arts, the program is designed to give young jazz musicians a taste of what a Juilliard Jazz student s life is all about and to help them refine their technique, improvisation and performance skills. Teachers include Juilliard Jazz faculty, current senior students and alumni. Instruments for the Juilliard Summer Jazz Camp in Atlanta: Trumpet, Saxophone, Trombone, Guitar, Piano, Double Bass, and Drums. Please note: Guitar and Double Bass students are required to bring their own instruments, amplifier and pick-up cables to all rehearsals and performances. There is no vocal program. Atlanta, GA June 17-21, 2012 Application Deadline: May 1, 2013 For details see Juilliard s Web site: juilliard.edu/summerjazz or call (212) ext. 7380

3 Program Schedule The day begins with Musicianship Class followed by Individual Practice and Small Ensembles Class. After lunch, students have additional ensemble rehearsals, listening sessions, and a daily Jam Session. The camp concludes with a concert featuring all students. The daily schedule is from 9:00 am to 5:00 pm and includes individual practice time. Sample Days Day 1: 9:00am 12:00pm Placement 12:00pm Lunch 1:00pm Small Ensembles 2:00pm Listening Sessions 3:00pm Large Ensembles 4:15pm Jam Session 5:00pm End of Day Daily schedule is subject to change. Day 2-4: 9:00am Musicianship 10:00am Individual Practice time 11:00am Small Ensembles 12:00pm Lunch 1:00pm Small Ensembles 2:00pm Listening Sessions 3:00pm Large Ensembles 4:15pm Jam Session 5:00pm End of Day Day 5: 9:00am 11:00am Ensembles Rehearsal 11:00am 1:00pm Dress Rehearsal 1:00pm 2:30pm Lunch/Break 2:30pm Concert Run-Through 4:00pm Dinner 6:00pm 9:00pm Concert Music Requirements for Juilliard Summer Jazz Residencies in Atlanta 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 Now s 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 Camp will take place at North Atlanta High School Center for the Arts, 2875 Northside Dr. NW, Atlanta, GA Students and parents are expected to make their own transportation arrangements; no bus will be provided. All students are required to bring their own lunch. Please contact the Juilliard Jazz Office at (212) ext if the student has special needs. Admissions The Juilliard Summer Jazz Camp will take place June 17-21, Applicants should complete the attached application; the application deadline is May 1, A completed application includes the application form and a $150 non-refundable, non-transferable tuition deposit (check or money order made payable to the The Juilliard School). Tuition and Application Timeline Total Tuition $400 Tuition Deposit $150 (non-refundable/non-transferable) due May 1, 2013 (Check made payable to The Juilliard School) Application ALL LINES COMPLETED due by May 1, 2013 Remainder of Tuition $250 (non-refundable/non-transferable) together with Emergency Contact Form, Insurance Form and Consent Form due May 15, 2013 (Check made payable to The Juilliard School)

4 Application (Due by May 1, 2013) Section 1: Applicant Information Please fill out the application completely. For any questions contact the Juilliard Jazz Office at (212) ext Name: Primary Address: Street Address Apt Number Home Phone Number Cell Phone Number Address Male Female Date of Birth: Age as of September 1, 2012: T-Shirt Size: XS S M L XL MM/DD/YY 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 guitar piano Section 2: School Information Name of School attended September 2012: School Address: School Phone: Music Teacher at School: Name of School attending September 2013: Grade Level in September 2013: Musical Background Primary Music Teacher: Years of Study: Have you taken private lessons? Yes No If yes, how long? Other Instruments played: Other Music Program(s) attended: Background Information Ethnic Background (optional): African, African-American Hispanic American, Latino Multi-racial (specify): Asian American Native American, American Indian Caucasian American Other (specify): Section 3: Parent/Guardian Information Child Lives with: (Circle One) Mother Father Both Other: Mother/Guardian Name: Primary Address: Street Address Apt Number Home Phone Number Work Phone Number Cell Phone Number Address (1) Address (2) Father/Guardian Name: Primary Address: Street Address Apt Number Home Phone Number Work Phone Number Cell Phone Number Address (1) Address (2) 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 The Juilliard School) to: Office of Jazz Studies, The Juilliard School, 60 Lincoln Center Plaza, New York, NY 10023

5 Emergency Contact Form (Due by May 15, 2013) Applicant Name: Gender: Male Female Address: Street Address Apt Number Home Phone Number Cell Phone Number Date of Birth: MM/DD/YY Parent/guardian Name: Home Address: (if different from above): Street Address Apt Number Business name and address: Home Phone Number Business Phone Number Second parent/guardian Name: Home Address: (if different from above): Street Address Apt Number Business name and address: Home Phone Number Business Phone Number Emergency Contact Information: Please list an emergency contact, other than parent or guardian, who will be available to pick up child. Name: Relationship to residency participant: Home Phone Number Cell Phone Number Work Phone In the event a child needs to see a physician, the Atlanta Public School (APS) 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, APS means the sponsor of the activities in which the registrant engages in the school known as North Atlanta High School Center for the Arts. Also in this document, school property refers to instruments and equipment owned by APS 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 camp 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: Signature of parent or guardian Date: Relationship to residency participant: NAME OF PARENT OR GUARDIAN (PLEASE PRINT):

6 Insurance Form (Due by May 15, 2013) Applicant Name: 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 camp? If yes, please explain below. Yes No Does your child have health problems? Yes No If yes, please explain: Please list special diet/food allergies: Allergies: Hay Fever Penicillin Drugs Insect Bites Nuts: what kind Asthma Food Other Please provide additional specific details PLEASE NOTE: Any accidents and illnesses must be reported to APS/Juilliard staff before the participant leaves the school each day. The camp 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 camp participant at all times. The APS and Juilliard are not responsible for monitoring and dispensing medication. PARENT/GUARDIAN AUTHORIZATION: The camp participant described has permission to engage in all camp activities except as noted by me in a separate letter (to be submitted with application). The camp participant and his/her parent/guardian agree to abide by the rules and regulations set up by the APS for health, safety and welfare of the camp. The following violations of camp rules will result in immediate dismissal without refund of fees: 1) Leaving North Atlanta High School Center for 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 camp program. Parent/Guardian Signature Date Residency Participant Signature Date

7 Consent Form (Due by May 15, 2013) Applicant Name: 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 child s name, picture, or video clips taken of my son/daughter to be used in APS/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 APS and The Juilliard School responsible for any accidents, injuries or other harm occurring to my child during the residency. Yes No Parent Printed Name Signature Parent/Guardian Date Completed emergency contact form, insurance form, and consent form must be received by May 15, Mail to: Office of Jazz Studies The Juilliard School 60 Lincoln Center Plaza New York, NY Questions? Please contact Juilliard Jazz Office at (212) ext. 7380

8 Joseph W. Polisi, President 60 Lincoln Center Plaza, New York, NY www. juilliard.edu In partnership with the Photos: Brent Cline

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