2021-2022 Registration Form 2021-22 RSM Private Lesson Registration Form Step 1 of 3 33% PROGRAM DESCRIPTION - Our music instruction focuses on developing a well-rounded musician. All private lesson students have the option to participate in enhancement activities, which includes student recitals (four per year), honors performance, musicianship classes, master classes, nursing home performances, community performances, competitions, county music exams and festivals. Photos and videos may be taken of students and parents at these special events and posted periodically on our website and social media with no names attached. REGISTRATION and COMMITMENT: Our 36-week Academic Year 2021-22 begins Sept. 7, 2021 and ends June 11, 2022 (please see our handbook for more details). The academic calendar can also be viewed on our website. Students may start our program at any time during the year. All woodwind, brass and voice lessons will be online until further notice. Piano, string, guitar and percussion students have the option to select online lessons or in-person lessons. Upon registration, students commit to the program through June 11, 2022.Student Name First Last Student Birthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student Age*Please enter a number from 3 to 100.School and Grade* Student Email* Enter Email Confirm Email Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Student Home Number*Student Mobile Number*Parent / Guardian Name (1)* First Last Parent / Guardian Email (1)* Enter Email Confirm Email Parent / Guardian Phone (1)*Parent / Guardian Name (2) First Last Parent / Guardian Email (2) Enter Email Confirm Email Parent / Guardian Phone (2)Emergency InformationAll information will remain confidential. Please tell us about any medical physical, or other concerns that may affect the applicant's participation in RSM programs. Lesson Location* In-person at the RSM studio Online All woodwind, brass and voice lessons must remain online until further notice. Piano, string, guitar and percussion students have the option to select online lessons or in person lessons. All students, parents and guests should wear a mask upon entering RSM until further notice (please see our handbook or our our COVID-19 precautions for more details).Instrument(s) of Study* Please provide the instrument(s) the student will study.Lesson Length* 30 minutes: $37.00 45 minutes: $55.50 60 minutes: $74.00 Please provide lesson length. Application fee: $33 for non RSM students.Lesson Time*Please provide 3 days and/or times you prefer to have your lesson (list in preferred order).Recitals December 18 March 19 June 11 Students participating in recitals must pay a $20 Recital Fee for each recital to be billed the month before each recital (i.e. Dec. 18th recital fee will be due Nov 1st). No late recital fees will be accepted. Fees are non-refundable or transferable. Students will select the recital(s) in which they want to perform. All recitals are held between the hours of 12:00 pm - 4:30 pm at the Slayton House. Attendance is free for parents and guests. If student is unable to participate in a recital during certain hours, RSM must be notified at least 4 weeks before each scheduled recital. Requests given less than 4 weeks before recitals will not be honored.Optional: Fall Musicianship Classes Tuesdays 6:00-6:45 pm (young musicians) Saturdays 10:00-10:45 am (older musicians) Prefer not to participate in musicianship class Musicianship classes present master classes as well as focus on theory, ear training and performance practice techniques. $65 fee for Fall Session classes due by Sept 14th. Classes begin Sept 21st thru Dec 4th (10 classes). No refund after the first class begins. Select a class to attend below.Optional: Spring Musicianship Clases Tuesdays 6:00 - 6:45 pm (young musicians) Saturdays 10:00 - 10:45 am (older musicians) Prefer not to participate in musicianship class Musicianship classes present master classes as well as focus on theory, ear training and performance practice techniques. $65 fee for Spring Session classes due by Jan 3rd. Classes begin Jan 11th thru Mar 26th (10 classes). No refund after the first class begins. Select a class to attend below. PLAN A: Payment in full. Full payment is due at the time of registration. A 5% discount is given for Plan A registration received through December 18, 2021 for first installment and June 11, 2022 for second installment. Tuition will not be prorated or credited for planned or unplanned missed lessons (must pay a minimum of four months). PLAN B: Monthly payment. Tuition balance will be paid in equal installments to be received no later than the first day of each month with credit card, cash, or check. Tuition may be paid online, mailed, placed in drop box, or through our recurring payment system. Monthly tuition will not be prorated or credited for planned or unplanned missed lessons. Choose Desired Payment Plan* Plan A Plan B Late Fee*Tuition is due the first of the month. If tuition is late, student will not be permitted to receive lessons unless tuition is received 24 hours before lessons begin. If tuition is not received by the third of the month, a $25 late fee will be applied to student’s tuition. No make-up will be given for this missed lesson. If tuition is not received by the 14th day of the month, student will be withdrawn from RSM. Note: A $35 fee will be charged for checks or credit cards that are unable to be processed. (Initial to accept terms.) * Billing Method* Email Invoice Recurring Payments (fill our required form at RSM) Invoice(s) will be emailed if recurring payment is not preferred. Select the method you prefer: * Invoice Email Address* Enter Email Confirm Email Make Up Lesson Policy*PLEASE NOTE: Due to limited availability in teacher's schedule, students will be given (2) two make-up lessons for the academic year for any absences if a 24-hour notice is given. This includes last minute cancellations due to traffic as teacher needs adequate time of notification and must be compensated for their time. These make-up lessons will occur online via Zoom unless teacher is available to give a face-to-face make-up lesson. No other make-up lessons will be guaranteed beyond two make-up lessons. All make-up lessons must be completed by June 11th. After June 11th, any incomplete lessons will be forfeited. In case of inclement weather, emergency closure or administration leave, lessons will be rescheduled for an alternate day. Please see our handbook for more details. If students are sick or experiencing COVID related symptoms including last minute illness, they should not attend class in-person and should contact the RSM office as soon as possible. An online session may be offered instead. Parent / Caregiver Responsibility*Parents/Caregivers should be on time to pick up their child/children once lessons or classes have ended. Parents/Caregivers are financially responsible for any damages to RSM’s materials, equipment or property incurred by their children. (Initial to accept terms.) Cancellation*Two-week written notice must be given to the RSM Office for lesson termination. RSM reserves the right to terminate lessons for non-payment of tuition. (Initial to accept terms.) Declaration* I have indicated my chosen tuition payment plan and billing method on this form. I agree with the contents and policies of this registration form, photo/imaging guidelines and the 2021-2022 parent/student handbook. (To authorize and accept, please initial and date.) Printed Name*Please provide the name of the person completing the form. Comments or QuestionsPhoneThis field is for validation purposes and should be left unchanged.