Vita Institute for the Arts does not discriminate on the basis of race, color, religion, ethnicity, national origin, age, sex, sexual orientation, political beliefs, or marital,veteran, or disability status in administration of its educational or admissions policies.
If you have any questions about this application form or would like to speak with either Dr. Edwards, Dr. Seastrum or Professor Wells please contact Vita at: firstname.lastname@example.org.
Focused Area of Study for which I am applying: (please select one)
- Theatre: Acting/Scriptwriting: Dr. Paul Edwards: The Character of Place: Theatre Through a Different Lens. __________
- Two-Dimensional Art: Composition: Dr. Don Seastrum: The Character of Place: Space, Color, and Light. ____________
- Three-Dimensional Art: Jennifer Wells: The Character of Place as Jewelry and/or Sculpture. _____________
First Name: _____________________________________
Last Name: _____________________________________
Date of Submission : _______/ ___________/__________
Street Address: _________________________________
City, ______________ State___________________ Zip Code _____________
Preferred Phone Number ________. _____ . _____________
Secondary Number __________. ________ . ___________
Email Address __________________________________
Please select one of these two options:
I will be using the SRISA housing option: _________
I will not be using the SRISA housing option. I will arrange for my own accommodations during the four weeks of the program: ________
Waiver of Liability
This agreement releases Vita Institute for the Arts (Vita), Vita Board Members, Vita employees, Independent Contractors employed by Vita from all liability relating to injuries that may occur during the course of study “Composition Studies in the Visual Arts.”
By signing this agreement, I agree to hold Vita Institute for the Arts (Vita), Vita Board Members, Vita employees, Independent Contractors employed by Vita entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence.
I also acknowledge that there are risks involved in taking art classes abroad. These include but are not limited to personal inquiry, death, dismemberment, and/or economic loss. I affirm that I am participating voluntarily, and that all risks have been made clear to me.
Additionally, I do not have any conditions that will increase my likelihood of experiencing injuries while engaging in this activity.
By signing below I forfeit all right to bring a suit against Vita Institute for the Arts (Vita),Vita Board Members, Vita employees, Independent Contractors employed by Vita forany reason. I will also make every effort to obey safety precautions explained to me verbally. I will ask for clarification when needed.
I, _________________________________, have carefully read, fully understand and agree to the above terms.
Photograph and Imagery Release Form
I give Vita permission to use my name, image, voice, and/or appearance as such may be embodied in any pictures, photos, videos, digital images, and the like taken or made on behalf of Vita Institute for the Arts. I agree that Vita has ownership of such pictures, etc, and may use them for any purpose consistent with Vita’s mission. These uses include, but are not limited to Vita marketing materials, social media, website, brochures, and any promotional or educational materials. I hereby release Vita and its agents from any and all claims which may arise out of or are in any way connected with such use. I understand that should I wish to rescind permission to such use I must provide an official request to email@example.com stating my desire for such pictures, etc. not to be used.
Yes, I have read and understand the information set forth above, and give my consent for my name and likeness to be used to promote Vita
Yes, I, _________________________________, have carefully read, fully understand and agree to the above terms.
Please fill out this form, sign the Waiver of Liability, make checks payable to Vita Institute for the Arts and mail the form to : Vita Institute for the Arts P.O. Box 7006 Gunnison, Colorado 81230