Colorado Academy Reg Form

Media / Photo Release

Click here to view the details of our Media Release Agreement
Can we use your name? *

Full Name First Name Only Anonymous No, you may not
⏺ I authorize and grant Vocal Jazz Academy (VJA) to capture my photo/video during the Academy event, as it pertains to my participation and performance.

⏺ I grant VJA permission to use my photos and/or performance videos on the VJA Website, Facebook, Twitter, Instagram, YouTube, and other social media platforms.

⏺ I allow VJA to edit, alter, copy, or distribute the photos and/or videos for social media advertising and marketing.

⏺ I understand that I will not receive any monetary compensation for photos/videos captured during my participation in the Academy.

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✅ Please select one: *

I agree to this Release as stated. I choose not to grant permission.
Date of Birth (if under 18)

Month Day Year
Date
Signature (if under 18 years of age, must be signed by parent or legal guardian): *

Clear
Date Signed *

Month Day Year
Date
Medical Release Information

Participants under 18 are REQUIRED to fill out this section, otherwise OPTIONAL

Enter Medical Release Information Here
Medical Insurance Carrier
Policy/Record Number
Allergies
Current Medications
Special Medical Considerations/Concerns
Emergency Contact #1 Name
Relationship to Participant
Phone Number
Please enter a valid phone number.
Emergency Contact #2 Name
Relationship to Participant
Phone Number
Please enter a valid phone number.
Guardian Consent:

I give permission for my student to attend Vocal Jazz Academy. I give permission for my student's director (if present) or a VJA staff member to seek any necessary medical help for my student during the Academy.
Consent Statement:

I agree

Academy Registration Payment Options:
- Pay with Credit Card / PayPal
- Submit school Purchase Order
- Create an Invoice for Payment at a later date
Clicking "Register & Proceed To Pay" will submit your registration and take you to the payment page.

DOWNLOAD OUR APP: After your registration is submitted and paid, you will be sent a link to download the app we have created for your Academy location - schedules, mass choir music, and much more will be distributed through that app.

FACEBOOK: Like us and get in touch with other participants as we prepare for an amazing vocal jazz experience!
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