This form is best filled out on a desktop/laptop.

To save this form and return at a later time, scroll to the bottom of the page and click “Save and Continue Later."

Includes Permission Form and Code of Conduct and Discipline Form. There are two separate forms—please read and sign each, then click the submit button when finished with both.


  • This form is to be used in consideration for allowing a student to participate in the Summer@Eastman Programs. THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS. PLEASE READ IT CAREFULLY BEFORE SIGNING.

    In consideration for allowing the above-named student (“Student”) to participate in the Eastman School of Music (“School”) Summer@Eastman Programs (defined as: High School Jazz Workshop, Adventure Music Camp, Keyboard Explorations I, Keyboard Explorations II, Guitar Intensive Workshop, Adult Chamber Music Workshop, High School Wind Ensemble Workshop, Summer Percussion Ensemble Intensive, Early Childhood Music Program, Summer Studio Orchestra, Summer Gamelan Workshop, Mandolin Workshop – Introductory, Mandolin Workshop – Intermediate, each of the foregoing a “Program”), I, as Student’s parent/guardian, understand and agree that:


    Student has my permission to attend all parts of the Program.


    Participating in the Program involves a risk of injury or harm. All such risks are being assumed knowingly and voluntarily by me and Student, including but not limited to those associated with travel to and from the program. These programs involve receiving classroom and/or private music instruction, and so carry the usual risks of such activities including, but not limited to, physical injury and/or illness from falls, insect or animal bites, athletic contact, transportation accidents, food contamination and chemical exposure.


    Student is physically fit and in a condition that will allow him or her to participate fully and safely in the Program. Student has medical insurance that covers him or her for accidents and illnesses while participating in the Program. I understand the School has not made, nor will make, any investigation into Student’s physical fitness or ability to participate in the Program and the School relies on my statement of Student’s physical condition. I assume full responsibility for payment of medical expenses not covered by insurance incurred as a result of Student’s participation in the Program.


    Occasionally, students deal with emotionally challenging issues. Summer@Eastman staff members are trained to assist students in adjusting to a new environment, a rigorous class schedule, and the challenge of being away from home for a substantial amount of time. The Summer@Eastman Programs at the Eastman School of Music do not have the facilities or staff to assist students experiencing serious emotional distress; any student who exhibits behavior that poses a threat to the health or safety of him or herself or others may be required to leave the Program immediately.


    I hereby release and indemnify the University of Rochester and the School, their employees, officers, Trustees, and volunteers (“Releasees”) from any and all liabilities, losses, claims, demands, costs, and expenses of any nature whatsoever arising out of any loss, personal injury (including death), or property damage, that I or Student may sustain, arising from Student’s participation in the Program, and due to any cause whatsoever, including the Releasees’ own negligence, unless due directly to the gross negligence or willful misconduct of the Releasees. It is my express intent that this Agreement shall bind the members of my and Student’s family, estate, heirs, administrators, assigns, or personal representatives. I understand that Student’s participation in the Program is entirely voluntary, and I sign this document freely and voluntarily, having read and understood it.

    I agree to abide by the School’s regulations. I understand that all fees must be paid prior to the beginning of instruction and that no deduction or refunds will be made for late arrival, early departure or expulsion.


    Your signatures below indicate that you have read and understand the information outlined above.

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY

  • The Summer@Eastman Programs (each a “Program”) at the Eastman School of Music (hereafter “School”) create a living and learning experience designed to challenge high-achieving high school students. Participating in this unique experience, however, carries some responsibilities. As members of the learning community, program participants (hereafter “Students”) are expected to meet the challenges of the rigorous academic program and participate with enthusiasm in community activities. It is also expected that personal integrity, respect for the rights of others, and a positive attitude will enable Students to maintain the highest standards.

    This Code of Conduct is intended to promote group cohesiveness and foster an environment conducive to the achievement of the Program’s goals. If a Student is unsure what this Code or any policy means, he or she has the obligation to ask.

    Compliance with this Code of Conduct is required of all Students. Failure to comply may, at the discretion of the School, result in dismissal from the program. In the event of a significant violation, the Student’s parent or guardian will be contacted.


    Program participants shall be respectful of the Eastman School of Music community, which includes people with diverse backgrounds and beliefs. Conduct that is disrespectful or demeaning to others, including but not limited to verbal or physical harassment, will not be tolerated.


    The following actions are prohibited during any part of the Program (including field trips and transportation as well as on the School campus):

    • Possession, use, distribution, or being in the presence of alcohol or illegal drugs
    • Misuse of prescription drugs
    • Use of tobacco products
    • Possession or use of weapons (including--but not limited to--firearms, fireworks or other explosive materials, knives, or other items intended or commonly used to inflict harm) -- any weapon found will be confiscated.
    • Disorderly Conduct (including but not limited to):
      • Fighting, including hitting or pushing another person, either as an aggressor or in response to actions of another.
      • Behavior that is otherwise reckless, disruptive, or dangerous to person or property.
      • Verbal or physical harassment of others including, but not limited to, bullying, cyberbullying and playing pranks or practical jokes, including via electronics.
      • Misuse, damage to, or theft of School property. Students will be liable for damage to Eastman School of Music property. The use of tape and the driving of nails, screws, or tacks into walls or furniture is prohibited. No furniture may be moved out of the assigned quarters, and no equipment (other than occasional pieces such as bookcases, table, lamp) may be added without permission. Damages found or additional cleaning that needs to occur upon check out time will be documented and billed to the Student’s account. Common charges are as follows: additional cleaning range from $35.00 to $125.00; replacement of a room key $125.00; damages to furniture or property range from $50 for scratches to furniture to the cost to replace.
      • Tampering with or misusing fire or emergency equipment.
      • Use of a camera, cell phone or other video or audio recording device in spaces where privacy is expected, such as restrooms, showers, locker rooms and bedrooms being used by others.
      • Failure to comply with the reasonable request of an Eastman School of Music official, including requests regarding COVID-related guidelines.
      • Interaction of a sexual nature or sexually suggestive manner with any other person (applies to any student under the age of 18).
      • Traveling outside the designated campus area boundary or leaving campus without permission or supervision.
      • Allowing non-residential visitors into students’ rooms. Housing is limited to registered students only.

    Students and parents may be held financially responsible for any damage to or loss of School property caused by Students.


    While Students may carry their cell phones, the phones should remain off during class time and should not be visible, unless otherwise instructed by Summer@Eastman faculty. We reserve the right to take a student’s phone if the student is asked to put it away and refuses. The cell phone will be returned to the student at the end of class. Repeated violations may result in dismissal from the Program.


    Coming to class is a very important part of the Program, and it will be difficult to understand the academic material without attending every class. Classes should only be missed in the case of an emergency or illness. If this is the case, please contact the instructor and Residential Life as soon as possible via email or phone.


    As members of an academic community, students assume certain responsibilities. One of these responsibilities is to engage in honest academic work. Academic dishonesty may include plagiarism (misrepresenting someone else’s work as one’s own), copying the academic work of a fellow student, or collaborating with another student unless permitted by the instructor. These are serious violations of the trust upon which an academic community depends. Academic dishonesty may lead to dismissal from the Program.


    Summer@Eastman may contact parents using the phone numbers provided in the application and for the following instances:

    • *Any illness or injury
    • Alcohol or Other Drug use
    • Multiple unexcused absences
    • Multiple violations of any policy
    • **Student Dismissal from the program (due to unacceptable behaviors)

    * Students with a positive COVID test result will be placed in isolation. Any participant with a confirmed positive test for COVID-19 must be picked up by a parent, guardian, or other responsible adult within 24 hours. Every student should have a backup plan in place for returning home unexpectedly due to a positive COVID test, and families should consider what travel restrictions may be in place for students in this situation.

    **If a student is dismissed from the program, a parent/guardian is required to pick them up immediately upon receiving notice. The Eastman School of Music is not responsible for arranging additional supervision of participants who have been dismissed from the program.


    Alcohol and Other Drugs; Damage to facilities; Weapons; Harassment; Violence:

    May result in dismissal from the program

    Noncompliance with COVID guidelines:

    Warning; $50 fine and Parental notification; dismissal from the program

    Hall Sports/Roughhousing:

    Warning; $50 fine for each offense thereafter

    Unexcused Absence:

    Warning; Parental Notification; $50 fine; dismissal from program

    Leaving Eastman Campus without permission:

    Parental Notification; $50 fine; dismissal from the program


    I agree to attend all scheduled classes/coachings/lessons, participate in all events, and to abide by the rules and regulations given in this form and in supplemental materials, if applicable. I have read and understand this Code of Conduct. I understand that if I do not comply with the Code of Conduct I may be dismissed from the Program. I understand that all fees must be paid prior to the beginning of instruction and that no deduction or refunds will be made for late arrival, early departure or expulsion. If dismissed from the Program, I will remain in a designated area until pickup or departure from the Eastman Campus within 24 hours of receiving notice.

    If tested positive for COVID, I understand that I will be placed in isolation and I must be picked up by a parent, guardian, or other responsible adult within 24 hours.


    Your signature below indicates that you have read and understand the Code of Conduct outlined above.

  • MM slash DD slash YYYY

    I hereby permit Student to attend the Summer@Eastman Programs and to be governed by Code of Conduct and any other applicable School rules. I have discussed with Student the Code of Conduct and the need to obey all rules, regulations, and instructions of Summer@Eastman Programs personnel. I understand that Student’s failure to obey the above may result in his/her dismissal from the Program. I also understand that all fees must be paid prior to the beginning of instruction and that no deduction or refunds will be made for late arrival, early departure or expulsion. If dismissed from the Program, I understand that Student will remain in a designated area until pickup or departure from the Eastman Campus, which should occur within 24 hours of the phone call made by the Program Director to the Student’s parent or guardian.

  • MM slash DD slash YYYY


    Please list names and phone numbers of parents/guardians and any other trusted adults (relatives, family friends) who have permission to pick up the child. If a parent/guardian, relative, or other adult is NOT authorized to pick up the child, please include their name and information in the “not authorized” section, below.

  • First and Last Name:Cell phone with area code 
  • MM slash DD slash YYYY