Thank you for using the 2008 On-line Chamber Music of the Rockies Application. Required fields are indicated with a *.
If you have any questions, call or email the CSI office before submitting your form.

(303) 399-5764. FAX: (303) 399-2999

email:

Student’s Personal Information

Name as it will appear on the student's badge:

*	Student's First Name
*	Student's Last Name
*	Instrument
*	Address
*	City
*	State (2 character abbreviation preferred)
	Postal Code
*	Country
*	Email Address
*	Evening Phone
*	Daytime Phone
*	Age on 6/1/2008
*	Birthdate (mm/dd/yyyy)
*	Name of Parent(s), (Whether coming or not)
*	Home Teacher's Name (Last Name, First Name)
*	Home Teacher's Address
*	Home Teacher's City
*	Home Teacher's State
*	Home Teacher's Postal Code
*	Home Teacher's Phone
	Home Teacher's Email

Deposit paid in '07 information

Deposit paid in '07 for - Session

None 1 2 Both

Do you need handicapped accessible classroom Yes No

* Current Repertoire being studied by student. List names of pieces and composers, any scale books or technical studies used:

* Orchestras and ensembles the registrant plays in currently (School and community orchestras, youth symphonies, string quartet experience, etc.):

* Which pieces have you performed in a Chamber Ensemble? List both year performed and movement.

Additional Notes:

T-Shirts (indicate quantity desired)

Size	Quantity	Costs	Total
Youth Small		@ $20
Youth Medium		@ $20
Youth Large		@ $20
Adult Small		@ $25
Adult Medium		@ $25
Adult Large		@ $25
Adult XL		@ $25
Adult XXL		@ $28
TOTAL

Summary of payment

Item	$	$
Tuition	$1040
Teen Lodge	$1380
T-Shirt Total
Scholarship fund donation (tax deductible)
International mail fee:	$0/$5/$10
Subtotal
Less deposit paid in '07
Total due
Total tuition due with application
Lodging due May 1, 2008

Directions to complete registration:

1. We recommend that you print this page for your records before submitting it to us.

2. Once you have submitted the application, a confirmation form will appear that totals your balance due. Print the summary of payment page for your records. We will email to you shortly an invoice along with directions to pay it online using a Visa or MasterCard charge card. If you prefer to pay by check, you can print the invoice and mail it to us along with a check.

3. After we receive your payment, we will email to you a musical confirmation number within 3 working days. You need this musical confirmation number to make lodging reservations at our reduced ‘Suzuki’ rates.

RELEASE FOR PROGRAM, ACTIVITIES AND EMERGENCY CARE

This statement is to be accepted by all adult participants and by the parent or guardian of student participants under the age of 18.

I hereby grant permission for my child to participate in the program offered by the Colorado Institute of Music and the Colorado Suzuki Institute and Chamber Music of the Rockies (hereafter collectively the “Institute”) and to participate in the extra daily activities and free clinics offered by the Institute. The Institute will use reasonable precaution for the participant’s safety. However, by the very nature of the activities and clinics offered, I understand that the Institute cannot guarantee the safety of every student.

On behalf of myself and my family, I understand, state and agree to hold the Institute, its officers, directors, employees and all those acting on behalf of the Institute, harmless from all liability of any kind by reason of any accident, injury or damage, whether to person or property, resulting from my, my family’s or the student’s participation in the Institute’s 2008 program, activities and clinics.

Any controversy, claim or alleged liability arising out of or relating to this agreement, or my, my family, or the student’s participation in the Institute’s 2008 program, shall be settled by arbitration administered by the American Arbitration Association, in Denver, Colorado and judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. Each party shall pay its own costs and attorney fees.

I hereby grant permission for the Director of Music, or the Director’s authorized personnel, of the Colorado Institute of Music, Inc. to obtain medical care on behalf of my child, the above named students, in the event of an emergency. I understand and agree that such action may include, but not be limited to:
a) Contacting a physician or paramedic;
b) Admitting the student to an emergency clinic or hospital;
c) Engaging the services of ambulance or other emergency vehicle.

I understand and agree that such action will be taken on behalf of the student and that I, as the student’s parent or legal guardian, shall be responsible for all costs and expenses of such emergency treatment.

It is possible that photographs of institute participants may be taken by the news media or by a staff photographer. By accepting the release of liability form you are giving permission for the Colorado Institute of Music to use your image/photograph in any official publication or presentation relating to the promotion of music education. This includes, but is not limited to, multimedia productions such as television, video, web sites, brochures, etc. and you release all rights to the aforementioned photograph/image. You also understand that you will not be compensated monetarily or in any other manner for the use of the image.

Name of Head of Household or Legal Guardian who is granting permission *

Errors detected in the application