Registration Form

Congratulations on your acceptance to the Colorado Chamber Music Institute! Please fill out the information below. You will also receive an email with additional items to fill out and send back to us via email or regular mail.

Name

First Last

Enter Student's Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Email

Phone

Additional Student Information

I agree to accept text messages or phone calls from teen counselors or institute staff as needed during the institute.*

I agree

Does the student have any health restrictions that would require handicap accessible living and class spaces?

Student's Gender*

Female
Male

Roommate requests (optional)

Food allergies - List any food allergies or sensitivities that we need to notify the restaurant and counselors about.

Parent Information

Parent Name:

Parent Email

Parent Phone

Parent 2 Name: (optional)

Parent 2 Phone: (optional)

Parent 2 Email: (optional)

Teen Lodge Code of Conduct

THE FOLLOWING WILL RESULT IN IMMEDIATE PARENTAL NOTIFICATION REGARDING DISCIPLINARY ACTION AND POSSIBLE DISMISSAL: • Boys in girls’ sleeping rooms • Girls in boys’ sleeping rooms • Smoking • Use of illegal drugs or substances • Illicit or wrongful use of legal drugs or substances • Violation of curfew • Leaving Beaver Creek without a counselor • Disruptive behavior • Absences from class/truancy The Director of Music of the Colorado Institute of Music shall have complete discretion as to any dismissal of a student from the Institute. In the event of any such dismissal, the student’s parent or legal guardian understands and agrees that they shall be responsible for any and all costs required to transport the student back to his or her legal address. They further understand and agree that a student’s dismissal from the Institute shall constitute a forfeiture of all tuition, costs, and registration fees paid.

Student Signature:*

I have read the Teen Lodge Code of Conduct and agree to it.

Parent's Signature:*

I have read the Teen Lodge Code of Conduct and agree to it.

Date of conduct agreement*

The Colorado Institute of Music Photo Release

I hereby grant the Colorado Institute of Music permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of the Colorado Institute of Music and will not be returned. I hereby irrevocably authorize the Colorado Institute of Music to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo. I hereby hold harmless, release, and forever discharge the Colorado Institute of Music from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW. I ACCEPT:

Student Signature for Photo Release:*

Date*

Parent Signature for Photo Release:*

Date*

Agreement to also complete Teen Lodge documents that will be sent in your confirmation email*

This application is registration for the CCMI program and doesn't include all health and liability release documents needed for the Teen Lodge. Students must return all requested Teen Lodge documents by April 15th. (Documents will be sent to you in your subsequent email confirmation.)

I agree

Additional Student Information

Parent Information

Teen Lodge Code of Conduct

The Colorado Institute of Music Photo Release

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