Please fill out and submit the following information and a VCM instructor will contact you in regards to scheduling. Student Referral Form Contact InformationRequested Start DateStudent's Name* First Last Date of Birth Date Format: DD slash MM slash YYYY Phone*Email* Parent/Guardian/Payer Name (if different from student) First Last Phone (if different from student)Email (if different from student) Preferred Contact Method Phone Email Musical Interest InformationWhich instrument(s) are you interested in studying?*Name of preferred instructor(s) (if known)Previous instructor(s) (if applicable)What is your past musical experience?Briefly describe your musical goalsWhich location would you prefer?* Downtown Victoria (900 Johnson Street) Westhills, Langford (210 - 1314 Lakepoint Way) Either AvailabilityPlease indicate the DAYS and TIME RANGES that will work best for you for scheduling lessons (up to 4, or enter more detailed information below) NOTE: Downtown and Westhills locations have different hours of operation, please see vcm.bc.ca/contact for full listAvailability (1 of 4)*AnytimeFlexibleSunday MorningsSunday AfternoonsSunday 3-6pmMonday MorningsMonday AfternoonsMonday 3-6pmMonday 6-9pmTuesday MorningsTuesday AfternoonsTuesday 3-6pmTuesday 6-9pmWednesday MorningsWednesday AfternoonsWednesday 3-6pmWednesday 6-9pmThursday MorningsThursday AfternoonsThursday 3-6pmThursday 6-9pmFriday MorningsFriday AfternoonsFriday 3-6pmFriday 6-9pmSaturday MorningsSaturday AfternoonsSaturday 3-5:30pmAvailability (2 of 4)*AnytimeFlexibleSunday MorningsSunday AfternoonsSunday 3-6pmMonday MorningsMonday AfternoonsMonday 3-6pmMonday 6-9pmTuesday MorningsTuesday AfternoonsTuesday 3-6pmTuesday 6-9pmWednesday MorningsWednesday AfternoonsWednesday 3-6pmWednesday 6-9pmThursday MorningsThursday AfternoonsThursday 3-6pmThursday 6-9pmFriday MorningsFriday AfternoonsFriday 3-6pmFriday 6-9pmSaturday MorningsSaturday AfternoonsSaturday 3-5:30pmAvailability (3 of 4)AnytimeFlexibleSunday MorningsSunday AfternoonsSunday 3-6pmMonday MorningsMonday AfternoonsMonday 3-6pmMonday 6-9pmTuesday MorningsTuesday AfternoonsTuesday 3-6pmTuesday 6-9pmWednesday MorningsWednesday AfternoonsWednesday 3-6pmWednesday 6-9pmThursday MorningsThursday AfternoonsThursday 3-6pmThursday 6-9pmFriday MorningsFriday AfternoonsFriday 3-6pmFriday 6-9pmSaturday MorningsSaturday AfternoonsSaturday 3-5:30pmAvailability (4 of 4)AnytimeFlexibleSunday MorningsSunday AfternoonsSunday 3-6pmMonday MorningsMonday AfternoonsMonday 3-6pmMonday 6-9pmTuesday MorningsTuesday AfternoonsTuesday 3-6pmTuesday 6-9pmWednesday MorningsWednesday AfternoonsWednesday 3-6pmWednesday 6-9pmThursday MorningsThursday AfternoonsThursday 3-6pmThursday 6-9pmFriday MorningsFriday AfternoonsFriday 3-6pmFriday 6-9pmSaturday MorningsSaturday AfternoonsSaturday 3-5:30pmADDITIONAL INFORMATION (use this space to supply any further details that may assist us in assigning the instructor that will suit you best)Pricing InformationTUITION: Lessons are available at four Fee Levels, depending on the experience of the instructor and the proficiency level of the student. Rates are $53, $63, $73 and $83 per hour, pro-rated for shorter lesson times. The VCM cannot guarantee the fulfillment of requests for specific Fee Levels, but will endeavor to match the student to faculty that represents the best possible fit for a musical education. For more information about fees, payment methods, refunds and withdrawals, please visit vcm.bc.ca/students/tuition-fees-and-payment-infoPlease indicate any financial restrictions for appropriate placement