2022-2023 Registration Form

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 2022-23 begins Sept. 6, 2022 and ends June 10, 2023 (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. Upon registration, students commit to the program through June 10, 2023.
Student Name*
First Last
Student Birthdate*
Student 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 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 Information
All information will remain confidential. Please tell us about any medical physical, or other concerns that may affect the applicant's participation in RSM programs.

PLAN A: Full payment is due at the time of registration. A 5% discount is given for Plan A registration received through December 17, 2022 for first installment and June 10, 2023 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: 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 Policy*
I agree to the late fee policy.
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.
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*
I agree to the make up lesson policy.
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 10th. After June 10th, 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*
I agree to the parent/caregiver responsibility policy.
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.
Cancellation*
I agree to the cancellation policy.
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.
Declaration*
I agree to the following declaration policy.
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 2022-2023 parent/student handbook.
Printed Name*
Please provide the name of the person completing the form.
Comments or Questions
Email
This field is for validation purposes and should be left unchanged.

2022-23 RSM Private Lesson Registration Form

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