2024-2025 Private Lesson Registration 2024-25 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: Academic Year 2024-25 begins Sept. 3, 2024 and ends June 7, 2025 (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 7, 2025.Absence Policy* I agree to the absence policy.Each instructor reserves a weekly lesson time exclusively for their students. There are no refunds for lessons missed due to student absences, and makeup lessons are not guaranteed. This includes scheduled absences and last-minute cancellations. We ask that you contact the office if you plan to miss your lesson. If a 24-hour notice is given, a teacher may make up a lesson in person or via Zoom if there is a cancellation in their schedule. No more than two makeup lessons will be offered for the academic year. No makeup lessons will be offered after the end of the academic year, June 8th. Please note, makeup lessons may be shorter than the student’s regular scheduled lesson. In the case of teacher’s absence, the teacher will arrange a makeup lesson, or a substitute may be provided. Students are not permitted to transfer minutes from their lesson to a sibling or friend. For inclement weather, see our website for cancellations. If students are experiencing sickness, they should not attend class in-person and should contact the RSM office as soon as possible. An online session may be offered instead.Student Name* First Last Is Student a Current or New/Returnng Student?* Current Student (no updates to email, phone number or address) Current Student (email, phone number or address updates) New or Returning Student $35 application fee will be applied for new or returning students. Phone Number to UpdateIf parent or guardian is updating the phone number, please indicate your name.Email to Update If parent or guardian is updating the phone number, please indicate your name.Address to Update 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 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 Student's Birthdate*MMMM123456789101112DDDD12345678910111213141516171819202122232425262728293031YYYYYYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student Age*School and GradeStudent 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 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 Student Home NumberParent / 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. Instrument(s) of Study*Please provide the instrument(s) the student will study.Lesson Preference* In Person Online Lessons will be held in person and online. Select your preference. Lesson Length* 30 minutes: $43.00 45 minutes: $64.50 60 minutes: $86.00 Please provide lesson length. Application fee: $35 for non RSM students. Desired Lesson Date(s) and Time(s)*Please provide 3 days and/or times you prefer to have your lesson (list in preferred order).Recital Fee (select the recitals planned to participate) Dec 21st Mar 15th Jun 7th Students participating in recitals must pay a $25 Recital Fee for each recital to be paid the month before each recital (i.e. Dec. 21th recital fee will be due Nov 1st). 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 – 3:30 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 $100 fee for Fall Session classes due by Sept 17th. Classes begin Sept 24th thru Dec 7th (10 classes). No refund after the first class begins.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 $100 fee for Spring Session classes due by Jan 14th. Classes begin Jan 21st thru Mar 29th (10 classes). No refund after the first class begins.Choose Desired Payment Plan* PLAN A: Payment in full. (minimum of 4 months) PLAN B: Monthly payment. 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 21, 2024 for first installment and June 7, 2025 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. 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 $10 fee will be charged for checks or credit cards that are unable to be processed. Billing Method* Email monthly invoices. Recurring payments (fill out 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 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 2024-2025 parent/student handbook. Printed Name*Please provide the name of the person completing the form.NameThis field is for validation purposes and should be left unchanged. Δ