Enrollment Form RCMNY Enrollment Students Students Full Name * DOB * Gender * Add another Student Remove Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Primary Number to Reach You * Phone Type * Home Call Email Provide us with a valid e-mail address and we’ll use it for sending invoices, announcements & school closing notifications. (We will not share this info with others). If student is under 18: Parent(s)/Guardian(s) Name Occupation Phone Add Another Parent/Guardian Remove In order to best serve our students’ needs, it is important for us to be aware of any learning, emotional or physical challenges that exist. Please share: How Did You Hear About US? * Student’s Primary Ethnicity * African-American Asian/Pacific Islander Caribbean Caucasian Hispanic Native American Bi-racial (please specify)Bi-racial (please specify) Other (please specify)Other (please specify) ** The following optional information is very helpful to us in applying for grants. Thank you! ** Instrument(s)/Course(s): * Preferred Instructor(s) * Student Type * New Student Returning Student Previous music instruction * Please check your preferred lesson dates and times. Scheduling is done on a first-come, first-served basis. Day * Mon Tue Wed Thu Sat Between Time * 121234567891011 : 0030 AMPM and * 121234567891011 : 0030 AMPM Add another Date/Time Remove Please check if enrolling in on-line lessons only. Non-refundable Registration Fee (required upon enrollment) * $50/student $75/family $20/scholarship family (registration fee waived for all enrollments submitted on or before June 1, 2020) Select Lessons Individual Lessons - 32-weeks - Pro-rated 30-min - $1,440 - $45 45-min - $2,176 - $68 60-min - $2,720 - $85 Suzuki Lessons - 32-weeks - Pro-rated 30-min - $1,600 - $50 45-min - $2,336 - $73 60-min - $2,880 - $90 Music for Life lessons - 32-weeks - Pro-rated 30-min - $1,920 - $60 45-min - $2,720 - $85 60-min - $3,840 - $120 Add (if there is another student) Remove Group Classes Group Classes - Full Year Music Theory** $475 - free for RCM Students Youth Choir $500 - $300 for RCM Students String Orchestra $550 - $300 for RCM Students Percussion Ensemble $300 Jazz Cats $500 - $300 for RCM Students Main Street Singers $325 Suzuki Group Classes $500 - free for RCM Students MS/HS MusicforLife Chorus T 6:30-7:30pm$40/wk TBI Chorus Th 1:00-2:00 pm $30/wk Add (if there is another student) Remove PAYMENT OPTIONS * Full Payment 100% at enrollment BI-PAYMENT PLAN 50% at enrollment; remainder January 1 MONTHLY-PAYMENT PLAN 25% at enrollment; remainder paid monthly TUITION ASSISTANCE PLAN 10% at enrollment; remainder paid monthly *** Late Payment: In the event that payment is not made in a timely manner, lessons may be suspended. Name On Card * Card # * EXP Date * Card Authorization * YES, I authorize RCM to charge my credit card on the payment due dates automatically. reCAPTCHA Submit If you are human, leave this field blank.
