Registration Form
Student's Full Name *
First
Your answer
Last
Your answer
Parent/Guardian Full Name *
Your answer
Student Date of Birth *
MM
/
DD
/
YYYY
Student's Grade *
Instrument *
Required
Location *
Required
E-mail *
Your answer
Phone Number *
Your answer
Home Address
Line 1
Your answer
Line 2
Your answer
City, State, zip code
Your answer
Preferred Days and Times for Lessons *
(or when you are NOT available)
Your answer
Student's Musical Background
(optional)
Your answer
Comments
Your answer
Studio Policy read and agreed *
A non-refundable annual registration fee of $25 per student is due with each completed Registration form. For more information about our Policy and payment options visit: www.rubinsteinacademy.com/policy.
Required
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