Gifford Family Theatre Overview Current Season Summer Arts Institute History Photos Student Name GenderMaleFemale Date of Birth Grade Completed June 2013 School Attended District Home Address City State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Home Phone Email NOTE 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 Camp(s) applying forFilm (7/1 - 7/12)Theatre (7/8 - 7/19)Musical Theatre (7/22 - 7/26)Visual Arts(7/22 - 7/26)Strings (7/29 - 8/2) Participating in Optional Extended Day Option?YesNo For all camps, please indicate t-shirt size (adult sizes)SMLXL 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 the photographs of my child in future publicity. I Agree Date 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. Student Name I give permission for emergency medical treatment Family Physician Name Phone Address Emergency ContactPlease 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. Name Address Phone Relationship to Student Please list anything in your child's health history, including allergies, which should be known. Insurance Company/Government Program ID or Contract Number Note 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. 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 threatre experience?YesNo If yes, please describe Section C Please complete this section for Musical Theatre Camp only Do you have any previous vocal experience?YesNo If yes, please describe Voice PartSopranoAltoTenorBassUnknown Have you ever taken private voice lessons?YesNo Can you read music?YesNo Do you have a performance piece ready?YesNo If yes, please list title Do you have any previous acting experience?YesNo If yes, please describe Section D Please complete this section for Visual Arts Camp only Have you had any previous fine art experience?YesNo If yes, please describe Section E Please complete this section for Strings Camp only InstrumentViolinViolaCelloBass How long have you been playing this instrument? Was your instructionPrivateSchoolGroup With whom have you studied How long have you been reading music? Have you been Suzuki trained?YesNo Do you have a polished piece for recital consideration?YesNo If yes, please list title and composer Also send me a copy Submit