JAZZJuilliard

For details see Juilliard’s Web site:juilliard.edu/summerjazz

One-week programs for dedicated and disciplinedstudents who are passionate about jazz music

In partnership with

Summer 2013Camp in West Palm Beach, FLJune 10-14 for students in Grades 6-8June 17-21 for students in Grades 9-12

of the palm beaches

JAZZJuilliard

Summer 2013Camp in West Palm Beach, FL

Application Deadline: April 15, 2013

For details see Juilliard’s Web site: juilliard.edu/summerjazzor call (212) 799-5000 ext. 7380

West Palm Beach, FL • June 10-14 • June 17-21

The Summer Jazz Camps in West Palm Beach, FL are one weekprograms for students who are dedicated, disciplined, and passionate

about jazz. Located at Oxbridge Academy of the Palm Beaches, theprogram is designed to give young jazz musicians a taste of what aJuilliard Jazz student’s life is all about and to help them refine theirtechnique, improvisation and performance skills. Teachers include Juilliard Jazz faculty, current senior students and alumni.

Instruments for the Juilliard Summer Jazz Camps 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 theirown instruments, amplifier and pick-up cables to all rehearsals andperformances.

• There is no vocal program.

Music Requirements for Juilliard Summer Jazz Camps in West Palm Beach, FLEach 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)

LocationAll classes and concerts for the Juilliard Summer Jazz Camps will take place at Oxbridge Academy of the Palm Beaches,3151 North Military Trail West Palm Beach, FL 33409. Students and parents are expected to make their owntransportation arrangements; no bus service will be provided. Lunch and snacks will be provided as part of the tuition.The program schedule may be adjusted according to enrollment. No housing is provided.

Please contact Oxbridge Academy of the Palm Beaches at 561-972-9601 if the student has special needs.

Admissions• The Summer Juilliard Jazz Camps will take place June 10-14, 2013 for Grades 6-8 and June 17-21, 2013 for Grades 9-12.• Applicants should complete the attached application; the application deadline is April 15, 2013.• A completed application includes the application form and a $150 non-refundable, non-transferable tuition deposit

(check or money order made payable to the Oxbridge Academy of the Palm Beaches).

Tuition and Application Timeline• Total Tuition $350• Tuition Deposit $150 (non-refundable/non-transferable) due by April 15, 2013

(Check made payable to Oxbridge Academy of the Palm Beaches)• Application – ALL LINES COMPLETED due by April 15, 2013• Remainder of Tuition $200 (non-refundable/non-transferable) together with Emergency Contact Form, Insurance Form, and

Consent Form due May 15, 2013 (Check made payable to Oxbridge Academy of the Palm Beaches)

Sample DaysDay 1:9:00am – 12:00pm Placement12:00pm Lunch1:00pm Small Ensembles2:00pm Listening Sessions3:00pm Large Ensembles4:15pm Jam Session5:00pm End of Day

Juilliard JAZZSummer 2013 Camps and Workshops West Palm Beach, FL •June 10-14 •June 17-21

Program ScheduleThe day begins with MusicianshipClass followed by Individual Practiceand Small Ensemble Class. Afterlunch, students have additionalensemble rehearsals, listeningsessions, and a daily jam session.The camp concludes with a concertfeaturing all students.

The daily schedule is from9:00am to 5:00pm and includesindividual practice time.

Day 2-4:9:00am Musicianship

10:00am Individual Practice time11:00am Small Ensembles12:00pm Lunch1:00pm Small Ensembles2:00pm Listening Sessions3:00pm Large Ensembles4:15pm Jam Session5:00pm End of Day

Day 5:9:00am – 11:00am Ensembles Rehearsal

11:00am – 1:00pm Dress Rehearsal1:00pm – 2:30pm Lunch/Break2:30pm Concert Run-Through4:00pm Dinner6:00pm – 9:00pm ConcertDaily schedule is subject to change.

Section 1: Applicant InformationPlease fill out the application completely. Should you have any questions during the application process, please do not hesitate to contact the Office of Jazz Studies at (212) 799-5000, ext. 7380.

Name: __________________________________________________________________________________________________________________________First Middle Last

Primary Address: ________________________________________________________________________________________________________________Street Address Apt Number

_______________________________________________________________________________________________________________________________City State Zip Code

_______________________________________________________________________________________________________________________________Home Phone Number Cell Phone Number E-mail Address

! Male ! Female Date of Birth: _______________ Age as of September 1, 2012: _______ T-Shirt Size: ! XS ! S ! M ! L ! XLMM/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 electric bass guitar piano

Section 2: School InformationName 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 InformationChild Lives with: (Circle One) Mother Father Both Other: __________________________________________________________

Mother/Guardian Name: ___________________________________________________________________________________________________________First Middle Last

Primary Address: _________________________________________________________________________________________________________________Street Address Apt Number

_______________________________________________________________________________________________________________________________City State Zip Code

_______________________________________________________________________________________________________________________________Home Phone Number Work Phone Number Cell Phone Number

_______________________________________________________________________________________________________________________________E-mail Address (1) E-mail Address (2)

Father/Guardian Name: ____________________________________________________________________________________________________________First Middle Last

Primary Address: ________________________________________________________________________________________________________________Street Address Apt Number

_______________________________________________________________________________________________________________________________City State Zip Code

_______________________________________________________________________________________________________________________________Home Phone Number Work Phone Number Cell Phone Number

_______________________________________________________________________________________________________________________________E-mail Address (1) E-mail 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 Oxbridge Academy ofthe Palm Beaches to: Mr. Cleve Maloon, 3151 North Military Trail, West Palm Beach, FL 33409 • (561) 972-9676

Juilliard JAZZSummer 2013 Camps • West Palm Beach, FL

Application (Due by April 15, 2013)

Camps (check one) ! June 10-14 ! June 17-21

Applicant

Name:________________________________________________________________________________________________ Gender: ! Male ! FemaleFirst Middle Last

Address: _______________________________________________________________________________________________________________________Street Address Apt Number

_______________________________________________________________________________________________________________________________City State Zip Code

_______________________________________________________________________________________________________________________________Home Phone Number Cell Phone Number

Date of Birth: ______________MM/DD/YY

Parent/guardian

Name: ___________________________________________________________________________________________________________________________First Middle Last

Home Address: ___________________________________________________________________________________________________________________(if different from above): Street Address Apt Number

_______________________________________________________________________________________________________________________________City State Zip Code

Business name and address: ________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________Home Phone Number Business Phone Number

Second parent/guardian

Name: ___________________________________________________________________________________________________________________________First Middle Last

Home Address: ___________________________________________________________________________________________________________________(if different from above): Street Address Apt Number

_______________________________________________________________________________________________________________________________City State Zip Code

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 Oxbridge Academy of the Palm Beaches cannot be responsible for transportation to and from thedoctor. 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 transportedby EMT services. In this document, “Oxbridge Academy of the Palm Beaches” means the sponsor of the activities in which the registrant engages inthe school known as Oxbridge Academy of the Palm Beaches. Also in this document, school property refers to instruments and equipment owned byOxbridge Academy of the Palm Beaches 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, andtreatment, to release any records necessary for insurance purposes, and to provide or arrange necessary related transportation, for me or my child. Inthe event my child experiences a medical emergency, and residency personnel try but fail to reach me or under the circumstances are withoutsufficient time to try to reach me, I hereby give permission to the physician or other medical personnel to secure and administer treatment, includinghospitalization, anesthesia, surgery, and injections of medication for my child. As long as the medical treatment considered necessary in thesituation is in accordance with generally accepted standards of medical practice for the particular type of injury or illness involved, I impose nospecific 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): ______________________________________________________________________________________

Juilliard JAZZSummer 2013 Camps • West Palm Beach, FL

Emergency Contact Form (Due by May 15, 2013)

Camps (check one) ! June 10-14 ! June 17-21

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 Oxbridge Academy of the Palm Beaches /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 Oxbridge Academy of the Palm Beaches 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 Oxbridge Academy of the Palm Beaches 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 Oxbridge Academy of the Palm Beaches 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.

Parent/Guardian Signature __________________________________________________________________________ Date _________________________

Residency Participant Signature ______________________________________________________________________ Date _________________________

Juilliard JAZZSummer 2013 Camps • West Palm Beach, FL

Insurance Form (Due by May 15, 2013)

Camps (check one) ! June 10-14 ! June 17-21

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 Oxbridge Academy of the PalmBeaches/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 benotified, the school has permission to seek medical attention for my child.

! Yes ! No

• I agree that I will not hold the Oxbridge Academy of the Palm Beaches and The Juilliard School responsible for any accidents, injuriesor other harm occurring to my child during the camp.

! Yes ! No

Parent Printed Name _____________________________________________________________________________________________________________

Signature Parent/Guardian __________________________________________________________________________ Date _________________________

Completed emergency contact form, insurance form, and consent form must be received by May 15, 2013.

Mail to:Mr. Cleve MaloonOxbridge Academy of the Palm Beaches 3151 North Military TrailWest Palm Beach, FL 33409

Questions? Please contact Mr. Cleve Maloon (561) 972-9676 or Marie Reese (561) 972-9601

Juilliard JAZZSummer 2013 Camps • West Palm Beach, FL

Consent FormCamps (check one) ! June 10-14 ! June 17-21

60 Lincoln Center Plaza, New York, NY 10023www. juilliard.edu

Joseph W. Polisi, PresidentPh

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In partnership with the

of the palm beaches