7 th Annual CHICAGO JAZZ PHILHARMONIC

7 th Annual CHICAGO JAZZ PHILHARMONIC Dear Students and Parents: Welcome to the 7 th Annual CJP Jazz Academy. We have an exciting jazz program lined up for the 2 weeks you will be part of our family. Chicago Jazz Philharmonic Jazz Academy is a two week intensive summer program that builds on CJP s school year programming known as JazzAlive. Students will develop skills and knowledge about music and performance through participation in various ensembles such as Jazz Band, String Ensemble, Guitar Ensemble, Drumline, and Handchimes. Additional courses offered range from Music Technology to Instrument Technique, as well as non musical electives such as Drawing to Music and Line Dancing. A full schedule will be delivered on the first day of camp with your Student Handbook. Below are few guidelines for your participation: Attendance is mandatory You should be present AND ON TIME everyday of the program Good Musicianship and Behavior is a must Bring your instrument every day. You must, sign, complete and return the attached forms before or upon checkin on July 20 st, 2015. If you gave any questions regarding the program please email Sarah Pietlicki at jazzacademy@chijazzphil.org. We look forward to seeing you on the first day of camp on July 20 st at 8:30AM at Chicago State University (9501 S. King Drive, Chicago). Sincerely, Sarah Pietlicki Jazz Academy Coordinator jazzacademy@chijazzphil.org chijazzphil.org/jazzacademy (312) 573 8932, x. 937

CHICAGO JAZZ PHILHARMONIC JAZZ ACADEMY Forms Checklist Your child will not be allowed to participate in the Chicago Jazz Philharmonic/ Jazz Academy if the following forms are not completed, signed, and returned by Monday, July 20, 2015. Waiver and Release Medical Information Form Camp Drop off / Pick Up Authorization Form Not required, unless you are signing up for/ordering (can also be found on line): Free Bus Shuttle from South Loop due July 15 th Daily Lunch Order Form due July 15 th DVD Order Form due August 8 th ** Any outstanding tuition balance is due by July 15, 2015. No child will be able to participate without complete payment and forms. Forms may be returned via: Fax: (312) 573 8933 Scan/e mail: jazzacademy@chijazzphil.org Post mail: Chicago Jazz Philharmonic ATTN: Jazz Academy 1111 N. Wells Street, Suite 501 Chicago, IL 60610 In person upon check in on first day of camp Daily Materials Checklist All students must bring the following items with them to the camp. Please mark items appropriately as the camp staff are not responsible for items that get lost or stolen. Checklist Instrument and all accessories: mouthpiece, reeds, oil, sticks, etc. Please note: we will not have access to music supplies Music Folder (Will be provided on the first day of camp) Name tag (Will be provided on the first day of camp) Camp T Shirt (Will be provided on the first day of camp and must be worn daily) Water Bottle Comfortable Shoes Medication with a note about how it should be administered

PARENT/GUARDIAN PERMISSION FORM AND RELEASE We, the parents and/or guardians of the minor child,, being years of age, hereby give permission for the minor child to attend the Summer Jazz Academy at Chicago State University. We recognize and understand that the minor child will be participating in musical activities as part of the Summer Jazz Academy, including those noted herein, among others, which may expose the minor child to risk of injury. We acknowledge that the minor child will be participating at his/her own risk. Furthermore, we understand that unless we have notified Chicago State University in writing that the minor child is unable to participate in an activity due to a physical or mental limitation, the minor child will be allowed to participate in all activities at the Summer Jazz Academy. If the minor child should suffer an injury or illness while at the Summer Jazz Academy, we authorize the employees of Chicago State University to use their discretion to transport or to have the minor child transported to a medical facility, and we accept full responsibility for that action. Furthermore, in consideration of Chicago State University allowing the child to attend the Summer Jazz Academy, July 20-24 & 27-31, 2015, we hereby do release and hold harmless Chicago State University and its trustees, officers, employees and agents against loss or damages (including reasonable attorney s fees) from any and all claims, or causes of action of any kind or nature that may be brought by or on behalf of the said minor child or by us arising out of any and all known or unknown, foreseen and unforeseen bodily or personal injuries, damages to property and consequences thereof which may be sustained by the said minor or by us arising out of or in connection with the Summer Jazz Academy. Furthermore, we agree to indemnify Chicago State University for any loss or damage to the premises, facility, or equipment of the Chicago State University caused by our minor child. Such indemnification shall include costs and expenses incurred by Chicago State University, including reasonable attorney s fees. I hereby give Chicago State University (CSU) and the Summer Jazz Academy (SJA) permission to use images of the minor that is attending (including any motion picture or still photographs made by CSU or SJA of my likeness, poses, acts and appearances or the sound records made by CSU of SJA of my voice) ("Images") for any purposes in connection with promoting CSU or SJA and its activities, which may include advertising, promotion and marketing. CSU or SJA may crop, alter or modify Images of me and combine such Images with other images, text, audio recordings and graphics without notifying me. We have read the foregoing release and understand that we are signing a complete release and bar to any claims, as defined above, resulting from our child s participation in Summer Jazz Academy at Chicago State University., 2015 Date Witness Signature of Parent or Guardian Signature of Parent or Guardian

SUMMER JAZZ ACADEMY Medical Release Form NAME OF STUDENT Address CITY STATE ZIP DATE OF BIRTH SEX GRADE (2015 2016 SCHOOL YEAR) PARENT (or guardian) NAME ADDRESS City STATE ZIP HOME PHONE ( ) WORK PHONE ( ) FAMILY DOCTOR NAME ADDRESS City STATE ZIP OFFICE PHONE ( ) Please give the name of your health/accident insurance carrier(s) and appropriate policy certificate number(s): NAME OF CARRIER CERTIFICATE NUMBER NAME OF CARRIER CERTIFICATE NUMBER Does this student have any chronic or acute medical problems or disabilities? Please Explain: List any allergies to food, pollen, or medicine: List any medications being taken at present time: My son/daughter does have permission to attend Chicago Jazz Philharmonic Summer Jazz Academy at Chicago State University. I give permission for my child to be given medical treatment as deemed appropriate. I will assume responsibility for any medical bills incurred by my child. Parent or Legal Guardian Date

SUMMER JAZZ ACADEMY Transportation Information Camp Bus: There will be a FREE camp shuttle bus. Students will be transported from Daystar School, 1550 S. State Street (parking lot entrance on 16 th St. between Dearborn and State St.), to Chicago State University each morning, and back from Chicago State University to Daystar each evening. Bus will depart at 7:45 AM each morning and return by 5:45 PM each evening. See sign up form for more information. Parent / Guardian Drop off and Pick up: Parent/guardian may choose to transport camp participants to and from campus in a private vehicle. To avoid the daily $5.00 parking fee, parent/guardians must purchase a Camp Access Parking Pass to gain access to the campus and drop of her/his child at the designated drop off location. This pass will allow you to access to campus for up to 30 minutes for the purposes of dropping off and picking up your camper. The fee for this pass is $5.00 for the 10 days of camp, and will expire on the last day of camp, Friday, July 31, 2015. To purchase a Camp Access Parking Pass, complete the Camp Drop off/ Pick up Authorization Form. On the first day of camp, Monday, July 20, provide your name to the Parking Attendant at the 99 th and King Drive campus entrance parking booth. The Parking Attendant will collect your $5.00 fee and issue you your parking pass. At all times, your Camp Access Parking Pass must be displayed properly on your vehicle rearview mirror to avoid a parking violation on campus. Failure to display the pass upon arrival will require payment of the $5.00 daily parking fee. To avoid parking congestion on campus, all camp participants must be dropped off and picked up at the B 1 parking lot, as indicated on the campus map. Public Transportation: Parents/Guardians may choose to allow their camper(s) to travel to and from campus via public transportation. Campers using public transportation must report directly to camp sign in location (Harold Washington Hall, Room 104) immediately upon arrival to campus. At the end of the camp day, campers using public transportation must leave campus immediately. To ensure the safety of all campers, the university reserves the right to require all unsupervised campers using public transportation to and from campus be 14 years or older. The CTA Campus Bus Stop/Drop off is located at 95 th and St. Lawrence, on the north side of our campus.

SUMMER JAZZ ACADEMY Camp Drop off / Pick Up Authorization Form Student Name: Parent/Guardian Name (Print): Home Address: Contact Number: Date of Birth (mm/dd/yyyy) Secondary Contact Number: I understand and acknowledge that my child will travel to and from Chicago State University as indicated by my initialed selection below. As the parent/guardian I take full responsibility for my child s daily travel needs to and from Chicago State University. Further, I understand my child is to arrive at Chicago State University within 15 minutes of the scheduled 8:30am start time and s/he must depart from campus within 15 minutes of the schedule finish time for each day. This authorization shall remain in effect until the close of camp, Friday, July 31, 2015. The following people are authorized to pick up my student from the Chicago Jazz Philharmonic Academy. I understand my student will be allowed to leave with these individuals only. I also understand that the person picking up my student must do so in person. Children will not be allowed to leave without being signed out. Photo identification may be required. I have selected the following mode of transportation for my child: Camp Bus Initial Here: (fill out enclosed form or sign up on line) Private Vehicle Drop Off / Pick Up I agree to purchase the University Camp Drop/Pick Up Pass for $5.00. Initial Here: The following individuals are permitted to pick up my child: Name: Relationship: Contact #: Name: Relationship: Contact #: Name: Relationship: Contact #: Public Transportation (Child must be 14 years of age or older) Initial Here: Check this box if your student has your permission to be dismissed without being picked up by an adult. Initial Here: Name of person(s) NOT authorized to pick up my student: Parent/Guardian Signature: Date: After 5:20 p.m., if a responsible person has made no contact to the Chicago Jazz Philharmonic Academy s Manager on Duty (Sarah Pietlicki (312) 573 8932, x. 937), a telephone call will be made to persons on the student s emergency contact list to arrange for pickup.

SUMMER JAZZ ACADEMY FREE BUS SHUTTLE Dates: Time: Drop off/pick up Location : Monday, July 20 Friday, July 31, 2015 (Mon Fri only) 7:45am Departure; 5:45pm Arrival Daystar School 1550 S. State St. (Parking Lot entrance on 16th St. between State and Dearborn) Yes! My child will ride the bus each day to/from CJP Jazz Academy. I understand that he/she must arrive at the pick up location by 7:45am and be picked up by 5:45pm each day. Student Name: Primary Adult Contact (for drop off; pick up): Name Cell Phone # Emergency Contact: Name Cell Phone # Optional Instructions/Remarks (please note any particular issues you foresee): We will refer to required Camp Pick up Authorization Form for authorized persons to pickup your child. Bus transportation will be provided by AM Bus Company. A designated Jazz Academy adult supervisor will accompany the students each day to/from camp. We expect that your child will be riding the bus to/from camp each day for all 10 days. The bus will depart promptly at 7:45am each day late arrivals will not be waited on. Frequent late pick ups will result in your child not being allowed to ride the bus for the remainder of camp. Please notify Jazz Academy at least 12 hours in advance if you know that your child will not be riding the bus on certain days. email: jazzacademy@chijazzphil.org phone: (312) 573 8932

SUMMER JAZZ ACADEMY DAILY LUNCH OPTION YES, I would like to receive daily lunch! I understand that I am opting in for a full two week lunch plan (10 lunches). The lunch will consist of one daily hot entrée, side, and a beverage. Student Name: Vegetarian or food restriction? (please explain): Food Allergies? (please explain): Amount Enclosed ($79.50 per student): LUNCH OPTION MUST BE ORDERED BY JULY 15 th Make Checks Payable To Chicago Jazz Philharmonic Please Write JAZZ ACAD LUNCH ON THE MEMO LINE Lunch Option may also be ordered online please visit http://www.chijazzphil.org/jazzacademy Chicago Jazz Philharmonic ATTN: Jazz Academy 1111 N WELLS St. #501 Chicago, Illinois

7 th Annual CHICAGO JAZZ PHILHARMONIC DVD ORDER FORM To order DVD s of the FINALE SHOWCASE and other highlights of our two week long Jazz Academy, Please complete this form and return with payment to Chicago Jazz Philharmonic Questions? Email jazzacademy@chijazzphil.org or call (312) 573 8932 Student Name: Parent Name: Telephone Number: Email: Mailing Address: City: State: Zip: Number of DVD s: Amount Enclosed ($15 per DVD): DVD ORDER FORM AND PAYMENT ARE DUE FRIDAY AUGUST 7 th 2015 Make Checks Payable To Chicago Jazz Philharmonic Please Write DVD ON THE MEMO LINE DVD s may also be ordered online please visit http://www.chijazzphil.org/jazzacademy Chicago Jazz Philharmonic ATTN: Jazz Academy 1111 N WELLS St. #501 Chicago, Illinois 60610