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Errors detected in the application
Enter the name exactly as it appears on your deposit invoice.
All fields are required:
Student's first name
Student's last name
State
(2 letter abbreviation ex. CO)

 

 

Thank you for using the 2008 On-line Student 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

* Session 1 2 Both
(Please complete two applications for those students registering for both sessions and playing different instruments in each session)
Session 1: Monday, June 9 - Saturday, June 14
Session 2: Monday, June 16 - Saturday, June 21
 
Name as it will appear on the student's name badge:
* First
* Last
* Instrument
* Book level as of today None or N/A 1 2 3 4 5 6 7 8 9 10 or beyond
* Age on 6/1/2008
* Birthdate mm/dd/yyyy
* Sex F M

Select all years you have attended CSI:
94 95 96 97 98 99 00 01 02 03 04 05 06 07 08

 

Contact Information

* Address
* City
* State (2 letter abbreviation ex. CO)
* Postal Code (use N/A if not required in your country)
* Country
Student's Email Address (printed in CSI booklet)
* Evening Contact Phone
Daytime Contact Phone (Parent)

Class Placement Information

* Instrumental Private Teacher’s Name (Last, First) Not required if registering as sibling/Parent or MR
* Teacher's Phone
* Teacher's Email (Errors in your teacher’s email address will result in delays. Use your own email if your teacher has no email. You can then print the teacher confirmation page, take it to your teacher for signature and mail or fax it to us.)

 

Please List your student’s placement accurately as of today’s date.
Do not anticipate where student will be working in the repertoire in June.


* Name * Book * Piece Number
* Polished Piece
* Newest Piece

 

Musicianship level:
(see Student curriculum, musicianship for level descriptions)


A B C D

 

Orchestra Level (String students at mid-book 3 and beyond are placed into orchestra without an additional fee. Check all that apply)

Never-ever played in orchestra before
School String Program, number of years
Youth Symphony/Community Orchestra, number of years
Suzuki Institute orchestra only, number of yrs:

 

Enrichment class options

All Students should indicate 4 enrichment choices in order of preference. Please verify enrichment choices with the student. Changing enrichment choices will change the date of your application and incur a $25 change fee.

First choice
Second choice
Third choice
Fourth choice

 

ONLY if registering as a sibling/parent, Please indicate the number of enrichment classes desired:

 

Additional Information

Name of Parent(s) attending as you want them to appear on a name badge

Badge #1: Firstname Last

Badge #2: Firstname Last

 

Do you need handicapped accessible classroom Yes No

* Is this your first ever Institute Yes No

From what source did you learn of the CSI (web, home teacher, mailing, friend, colleague, school, other)

Teen Lodge Program: name of roommate preference

 

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 fees

Item $ $
All levels beyond Twinkles, all instruments, per session $520
Music Readiness: all instruments per session $350
Violin Tuning class $34
Chamber Music Ensemble class additional fee $195
Sibling/Parent-enrichment classes, each $165
Teen Lodge, Meals and Social Activities -one session $640
Both Sessions $1,380
T-Shirt Total
Scholarship fund donation (tax deductible)
Less deposit paid in '07
Subtotal
Change of session Fee
Late Fee (Fees are in effect based upon the date we RECEIVE your tuition. Plan accordingly and ask your teacher to respond in a timely way to the teacher confirmation email.)

               Feb 10 - March 31      -  $25

               April 1 - April 30         - $50

               after May 1                  - $100

               after June 1                  - $150

$0/$25/$50$/$100/$150
Total

 

Directions to complete registration:

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

2. After you have submitted this application, a summary form appears. Review and print a copy for yourself before pressing ‘submit’ to email to your teacher. 

3. When we receive the email from the home teacher verifying the playing and musicianship levels for your student we will email to you an invoice for payment. 

5. You are able to pay the tuition invoice online securely using Visa or MasterCard. If you prefer to pay by check, you can print out the invoice and mail it to us along with your check. 

6. When we have received your payment in full, we will send you a confirmation number via email. 

7. With your musical confirmation number, you can then make your lodging reservations. 

Please enter the email address where you want your musical confirmation number sent. 

*

 

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 *

 

If you have any questions, call or email the CSI office before submitting your form.

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


Errors detected in the application

Please review this application. You will not be able to come back and re-submit an application using this name again. If you want to make any changes after you have submitted this application, use email to