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Registration Form
Please fill out the Registration Form and we will get back to you with possible dates and times for your lesson.
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* Indicates required question
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
*
Choose
1
2
3
4
5
6
7
8
9
10
11
12
Preschool
Adult
Instrument
*
Piano
Voice
Guitar
Violin
Cello
Clarinet
Group Lessons
Other:
Required
Location
*
ONLINE
WEST - Plymouth, MN
CENTRAL - St. Paul, MN
EAST - Woodbury, MN
SOUTH/WEST - Eden Prairie
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 $30 per student is due with each completed Registration form. For more information about our Policy and payment options visit:
www.rubinsteinacademy.com/policy
.
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