Student Registration Form

Student Registration Form

Fill out the form carefully to register for the waiting list
Complete the form below to register your interest in music lessons with Rubato Music Tuition. Please provide all relevant information to the best of your ability.

Lessons are in high demand and the timetable is currently fully booked.

When an appropriate place is available, registered prospective students will be notified by email and given additional information about how to reserve a place.
Student Name*

First NameLast Name
Date of birth of Student*

DayMonthYear
Preferred pronoun*
Contact Name (parent/ carer if student is under 18 years)

First NameLast Name
Contact email (parent/ carer if student is under 18 years)*
example@example.com
Contact mobile phone (parent/ carer if student is under 18 years)*
Please enter a valid phone number.
Address of Student*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School attended by Student
Student's current academic year
Name of any other family members currently registered with Rubato Music Tuition (if applicable)
I am interested in (tick all that apply):

Piano lessons: 1:1 at the Horsham Studio during school hoursPiano lessons: 1:1 at the Horsham Studio after school hoursPiano lessons: 1:1 at St. John the Baptist School, WokingPiano lessons: 1:1 at St Teresa's School, EffinghamPiano lessons: 1:1 onlineMusic Theory: group course onlineCoaching for Teachers
Current piano ability of student*

Beginner (no previous experience)Early Learner (up to Grade 2 standard)Improving Player (Grade 3-5 standard)Experienced Performer (Grade 6 standard and above)Returner (please state previous achievements below)Teacher
Previous musical experience
Please include name(s) of teacher(s), graded exams, recital/festival experience and any other instruments if applicable
Any other information you think we should know, including SEND
I have read, understood and accepted the Privacy Notice*

Yes
We would like to send you information about our services, by telephone and/or email. Please note that if you consent to being sent our information by email then your data will be shared with the third party organisation Mailchimp who will make contact on our behalf. If you agree to being contacted this way, please tick the relevant boxes:

EmailPhone
Should be Empty: