Pre-College Core Studio Concepts Registration Pre-College Core Studio Concepts 2023 "*" indicates required fields HiddenEffective Semester Parent signature required to complete registration formStudent InformationName* First Last Preferred Name Gender Identity* Male Female Other Please select your gender or specify preferred gender identity. Preferred Pronouns Date of Birth*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Do you consider yourself to be Latino(a) / Hispanic? Yes No In addition, please select one or more of the following racial categories to describe yourself: Native American or Alaskan Native Asian Black or African American Native Hawaiian or Pacific Islander White Non-Resident Alien Student Email Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country School Name* Graduation Year*20232024202520262027T-Shirt Size* Adult Small Adult Medium Adult Large Adult X-Large Adult 2XL Parent/Guardian InformationParent/Guardian Name* First Last Parent/Guardian Email* Parent/Guardian Home Phone*Parent/Guardian Work Phone*Class SelectionPlease Select 2 (two) courses* Basic Observational & Figure Drawing Painting Graphic Design Illustration Photography Comics Product Design Screenprinting $1,635.00Roommate Request Student will be staying in MIAD's residence hall?* Yes - $890.00 No Optional Workshop SelectionAll workshops are two night workshops that run from 6pm to 9pm. Please make sure to verify dates so that you do not schedule conflicting workshops.HiddenCeramics - $95 Monday, July 10 & Wednesday, July 19 - 6pm to 9pm Virtual Reality – Exquisite Corpse Sculptures - $95 Tuesday, July 11 & Wednesday, July 12 - 6pm to 9pm HiddenArt Therapy – Creating Calm - $95 Tuesday, July 11 & Wednesday, July 12 - 6pm to 9pm HiddenTextiles – Embroidery - $95 Thursday, July 13 & Thursday, July 20 - 6pm to 9pm Printmaking – Letterpress - $95 Thursday, July 13 & Thursday, July 20 - 6pm to 9pm HiddenPhotography – Cyanotypes & Photograms - $95 Monday, July 17 & Tuesday, July 18 - 6pm to 9pm HiddenRisography – Make Your Own Zine - $95 Monday, July 17 & Tuesday, July 18 - 6pm to 9pm Parental/Guardian ConsentParents must sign the form belowPublicity Release*I give permission for photographs to be taken of my child and/or their artwork in connection with the activities of the MIAD Pre-College program and its agencies for use on website, in newspapers, television, magazine articles, brochures, social media and presentations concerning the program. I agree to the Publicity Release. I do NOT agree to the Publicity Release. Parent/Guardian Signature - Publicity Release* Reset signature Signature locked. Reset to sign again Waiver Agreement* I agree to the Waiver Agreement.Should any injury occur during or as a result of participation in any MIAD class, workshop, camp, field trip or program, I agree to indemnify and hold harmless MIAD and all its employees, staff, instructors and volunteers connected with MIAD.Parent/Guardian Signature - Waiver Agreement* Reset signature Signature locked. Reset to sign again Activities Release* I agree to the Activities Release.I give permission for my child to participate in all MIAD Pre-College activities, chaperoned trips and events.Parent/Guardian Signature - Activities Release* Reset signature Signature locked. Reset to sign again Unclothed Model Release*I give consent for my child to work from the human form (nude adult models). I agree to the Unclothed Model Release. I do NOT agree to the Unclothed Model Release. Parent/Guardian Signature - Unclothed Model Release* Reset signature Signature locked. Reset to sign again Off Campus Release*I give consent for my student to leave campus unchaperoned during their lunch hour, and if staying in the Residence Hall, after school until the 7 p.m. return to campus curfew. Please see the MIAD Summer Pre-College Handbook for full details. I agree to the Off Campus Release I do NOT agree to the Off Campus Release Parent/Guardian Signature - Off Campus Release* Reset signature Signature locked. Reset to sign again Consent and digital signatureDigital Signature I understand that in the above statements, my digital signature and/or initials are equivalent to my manual signature.Signature Reset signature Signature locked. Reset to sign again ScholarshipScholarship Applications I will not be applying for a scholarship I will be applying for a DPI scholarship I will be applying for a Merit scholarship HiddenI am a MIAD intern I am a Design Internship applicant Registration Deposit Price: Total Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name I would prefer to receive my registration paperwork electronically If this is not checked, you will receive your registration paperwork in the mail.NameThis field is for validation purposes and should be left unchanged. Δ
