Summer 2021 Private Lesson Registration Form RSM Summer 2021 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 include student recitals, community performances, guest artist presentations, 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 9 week summer session begins Monday, June 21, 2021, and ends August 21, 2021 (please see our handbook for more details). The summer session calendar can be viewed on our website. Students must register for at least six weeks of private lessons to participate in our summer private lesson program. Upon registration, students commit to the weeks they request to have lessons. Application and first payment must be received at time of registration to reserve student’s preferred lesson day and time. Due to limited availability on teacher's schedule, students will not be given any makeup lessons during our summer session. Once students have submitted the weeks they wish to have lessons, week selections cannot be amended. Summer lessons will be held in person and online.Student Name First Last Student's Birthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student 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 Home 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. Instrument(s) of Study* Please provide the instrument(s) the student will study.Lesson Preference* In Person Online Summer lessons will be help in person and online. Select your preference. Lesson Length* 30 minutes: $36.00 45 minutes: $54.00 60 minutes: $72.00 Please provide lesson length. Application fee: $32 for non RSM students. Summer recital will be August 15th at RSM.Lesson Time*Please provide 3 days and/or times you prefer to have your lesson (list in preferred order).Week Selection* June 21-26 June 28-July 3 July 5-10 July 12-17 July 19-24 July 26-31 August 2-7 August 9-14 August 16-21 Select the weeks you are requesting lessons (minimum of 6 weeks required). Once application is submitted weeks cannot be amended: Monthly Payment: Tuition balance will be paid in equal installments to be received no later than the first business day of each month with credit card, cash, or check. Students requesting 6 weeks of instructions will be billed for one installment and must pay in full at registration. Students requesting 7-9 weeks of instructions will be billed for two installments. Tuition may be paid online, mailed, placed in RSM’s mailing drop box, or through our recurring payment system. Monthly tuition will not be prorated or credited for planned or unplanned missed lessons..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 out required form at RSM) Monthly invoices will be mailed or emailed if recurring payment is not preferred. Select the method you prefer. Invoice Email Address* Enter Email Confirm Email Missed Lesson*Makeup lessons will not be given during our summer session. Students are not permitted to transfer minutes from their lesson to a sibling or friend. (Please see our handbook concerning missed lesson policies.) A substitute teacher may be provided if teacher is absent. 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*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 2020-2021 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 QuestionsEmailThis field is for validation purposes and should be left unchanged.