Juilliard

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

June 11-15 for students in Grades 6-8

June 18-22 for students in Grades 9-12
One-week programs for students who are
dedicated, disciplined, and passionate about jazz
For details see Juilliards Web site: juilliard.edu/summerjazz or call (212) 799-5000 ext. 7380

Juilliard

JAZZ

Summer 2012
Camps and Workshops

he Summer Jazz Residencies in West Palm Beach, FL are one week

programs for students who are dedicated, disciplined, and passionate
about jazz. Located at Bak Middle School of the Arts, the programs are
designed to give young jazz musicians a taste of what a Juilliard Jazz
students life is all about; refining technique, performance, and broadening
understanding of various jazz styles. Teachers include members of the
Juilliard Jazz Studies faculty as well as Juilliard Jazz students.

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.

West Palm Beach, FL June 11-15 June 18-22

Application Deadline: May 2, 2012
For details see Juilliards Web site: juilliard.edu/summerjazz
or call (212) 799-5000 ext. 7380

Juilliard JAZZ
Summer 2012 Camps and Workshops West Palm Beach, FL June 11-15 June 18-22

Program Schedule

Sample Days

The day begins with Musicianship

Class followed by Individual Practice
and Small Ensembles/Combo work.
After lunch, students have additional
ensemble rehearsals, listening
sessions, Big Band rehearsal, and a
daily Jam Session. In addition to the
daily classes and rehearsals, the
repertoire studies during the week
will be performed on the final day of
the residency. Program structure may
be adjusted according to enrollment.

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

Students will be in session from

9:00 am to 5:00 pm with daily
required practice sessions.

Daily schedule is subject to change.

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).

Tuition and Fees

Application Timeline

Total Tuition $350

A complete application packet MUST include ALL of the following:

Tuition Deposit $150 (non-refundable) due by

May 2, 2012

Application ALL LINES COMPLETED by May 2, 2012

Remainder of Tuition ($200) is due by May 23, 2012

Tuition Deposit of $150 by May 2, 2012

(non-refundable, non-transferable) (check or money order
made payable to Middle School of the Arts Foundation)
Emergency Contact and Consent forms by May 15, 2012

Juilliard JAZZ

Application (Application Deadline: May 2, 2012)

Summer 2012 Camps and Workshops West Palm Beach, FL

Residency (check one)  June 11-15

 June 18-22

Section 1: Applicant Information

Please 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

 Male  Female

Date of Birth: _______________

E-mail Address

Age as of September 1, 2011: _______

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

Section 2: School Information

Name of School attended September 2011: _______________________________________________________________________________________________
School Address: ________________________________________________________________________ School Phone: ____________________________
Music Teacher at School: __________________________________________________________________________________________________________
Name of School attending September 2012: _____________________________________________________ Grade Level in September 2012: ________
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
 Asian American

 Native American, American Indian

 Hispanic American, Latino

 Caucasian American

 Multi-racial (specify): ____________________________

 Other (specify): _______________________________________

Section 3: Parent/Guardian Information

Child 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 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

Emergency Contact Form

Summer 2012 Camps and Workshops West Palm Beach, FL

Residency (check one)  June 11-15

 June 18-22

Residency Participant Name: ______________________________________________________________________________ Gender:  Male  Female

First

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 if needed during residency
Name: ___________________________________________________________________________________________________________________________
Relationship to residency participant: _________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
Home Phone Number

Cell Phone Number

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: ________________________________________________________________________________________________

Signature of parent or guardian ________________________________________________________________ Date: ______________________________

Relationship to residency participant: _______________________________________________________________________________________________
NAME OF PARENT OR GUARDIAN (PLEASE PRINT): ______________________________________________________________________________________

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

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 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.

Parent/Guardian Signature __________________________________________________________________________ Date _________________________

Residency Participant Signature ______________________________________________________________________ Date _________________________

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

Parent Printed Name _____________________________________________________________________________________________________________

Signature Parent/Guardian __________________________________________________________________________ Date _________________________

Completed emergency contact and consent forms must be received no later than May 15, 2012.
Mail to:
Mr. Cleve Maloon
Bak Middle School of the Arts
1725 Echo Lake Drive
West Palm Beach, FL 33407
Questions? Please call Ms. Rebekah Gilbert (212) 799-5000 ext. 7380 or Mr. Cleve Maloon (561) 882-3892.

Parent/Guardian (Printed) _________________________________________________________________________________________________________

Parent/Guardian (Signature) __________________________________________________________________________ Date ________________________

Notary Legal Name (Printed) ________________________________________________________________________________________________________________________________

Notary (Signature) __________________________________________________________________________________ Date ________________________

Commission Expiration Date: _______________________________________________ State: ________________________________________________

Notary Seal

Joseph W. Polisi, President

Photos: Brent Cline

60 Lincoln Center Plaza, New York, NY 10023

www. juilliard.edu