Summer Institute™ Registration Form

This form is for Summer Institute™ registrations.

Section I - Basic Info
Student's Name *
Student's Name
Birthday *
Phone *
Alternate Phone
Alternate Phone
Home Address *
Home Address
Mailing Address (if different from above)
Mailing Address (if different from above)
Section II - Parent/Guardian
Father/Guardian *
Work Phone
Work Phone
Cell Phone
Cell Phone
Work Phone
Work Phone
Cell Phone
Cell Phone
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
Section III - Private Lesson Info
Have you, at any time, taken private lessons on your "instrument of choice" outside of school? *
Do you perform/sing in any school ensembles? *
Have you ever taken private lessons on any instrument OTHER than your "Primary instrument"? *
If yes, which instrument(s)? *Check all that apply
Have you attended RCSM in the past? *
Section IV - Performance Background
Are you currently playing in a band? *
Section V - Abilities/Disabilities
*this information helps us better serve each student
Have ever been diagnosed, or considered for diagnosis, for any disabilities (i.e. learning, social, physical, emotional, etc.) *
*This helps us better serve you!
Financial Assistance
Are you applying for financial assistance? *
RCSM Policy *
I have read and agree with RCSM's policy
Image & Audio Release *
Occasionally, professional photographers, videographers, and/or audio engineers will visit private lessons, classes, camps and/or performances for us to maintain an up-to-date photo, video, and audio library for use in Rochester Contemporary School of Music publications, videos, social media, and website. If you, or your child, have an expressed objection to having your image included in photo, video, and/or audio publications, please advise us PRIOR to your first lesson or class. Otherwise, Rochester Contemporary School of Music reserves the right to select, print, and/or publish all images and audio recordings that are representative of our programs. (*NOTE: Rochester Contemporary School of Music will never print names of students without additional prior consent) I have read and accept RCSM's Image & Audio Release
Travel Release *
During Summer Institute™, students and faculty will travel for at least one field trip and a dress rehearsal at the performance hall in which we'll perform the final concert. Any traveling that is done during Summer Institute™ is necessary for the success of the camp. Do you give you child permission to travel with students and faculty for these purposes?
Registration Agreement *
The following agreement authorizes Rochester Contemporary School of Music (RCSM) to accept payment for educational services. It also denotes the student's willingness and commitment to participate in all required elements of RCSM's program, including but not limited to ensembles and public performances. The student (parent/guardian where applicable) also agrees to pay the required tuition and ALL applicable fees at the time of registration and consistently according to the billing options offered.