Fall 2021 Group Class Registration Form Fall 2021 Group Class Registration Form Step 1 of 3 33% PROGRAM DESCRIPTION - Our music instruction focuses on developing the whole musician. There are 14 weeks in our 2021 Group Lessons Spring Program. All class sessions are from September 7th – December 18th and last for 45 minutes per class. (please see our handbook for more details). ENHANCEMENT CLASSES: All RSM students have the option of participating in the December recital for an additional fee. 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. Please visit our website to view our calendar for details. Student Name First Last Student Age*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 Phone 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. Group Class (45 minutes) $396* Piano Prep/Early Childhood (4-5 yrs.): Thurs. 5:10 – 5:55 pm Beginning Piano (6-9 yrs.): Thurs. 6:10-6:55 pm Suzuki Violin (5-8 yrs.): Tues. 5:10 – 5:55 pm Adult Piano (17 and older): Tues. 6:10-6:55 pm Please select a class. Application fee: $33 for non RSM students. Materials: $25 for each class.Recitals December 18th 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 nonrefundable 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. Policies and Finance*Last day to register for all classes is August 31st. A one-time nonrefundable application fee of $33 is due at the time of registration for all new students. Each student will be charged $25 for materials. 50% of tuition and all fees are due at the time of registration. The remaining balance, $196, must be received by November 1st. Tuition will not be prorated or credited for any missed classes. 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 Monthly Invoices Recurring Payments (fill our required form at RSM) Monthly invoices will be emailed if recurring payment is not preferred. Select the method you prefer: * Invoice Email Address* Enter Email Confirm Email Missed Lesson*Students are encouraged to attend all classes. Make-ups will not be given for missed classes. Students are not permitted to transfer minutes from their class to a sibling or friend. For inclement weather see our website for cancelations. 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*Students may withdraw from class after first class with a prorated refund. After second class, students that withdraw will not receive a refund. 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.