Summer 2023 Private Lessons RSM Summer 2023 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 19, 2023, and ends August 19, 2023 (please see our handbook for more details). The summer session calendar can be viewed on our website. Summer lessons may be held in person or online. 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. If makeup lessons are requested, these make-up lessons will occur online via Zoom unless teacher is available to give a face-to-face make-up lesson.Student Name* First Last Is Student a Current or New/Returnng Student?* Current Student New or Returning Student Student's Birthdate*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student 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 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 Summer lessons will be help in person and online. Select your preference. Lesson Length* 30 minutes: $40.00 45 minutes: $60.00 60 minutes: $80.00 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).Week Selection* June 19-24 June 26-July 1 July 3-8 July 10-15 July 17-22 July 24-29 July 31-August 5 August 7-12 August 14-19 Select the weeks you are requesting lessons (minimum of 6 weeks required). Once application is submitted you must email the RSM office to amend weeks. RSM will be closed July 4th. Teacher will arrange makeup lesson if lessons are selected July 4th. 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 may be billed for two installments under our recurring payment plan (fill out form). 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 $35 fee will be charged for checks or credit cards that are unable to be processed. Billing Method* Registered for six weeks of summer lessons and will pay one installment at registration. Registered for 7-9 weeks of summer lessons and will pay all weeks in one installment at registration. Registered for 7-9 weeks of summer lessons and will pay summer lessons in two installments. First payment is due at registration. Second payment will be paid under recurring payment (fill out recurring form). Invoice Email Address* Enter Email Confirm Email Missed Lesson* I agree to the missed lesson policy.If makeup lessons are requested, these make-up lessons will occur online via Zoom unless teacher is available to give a face-to-face make-up lesson. 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* 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. 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