Referral Form - Individual Lessons - Victoria Conservatory of Music

Please fill out and submit the following information and a VCM instructor will contact you in regards to scheduling.

Student Referral Form

Contact Information
Requested Start Date
Student'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 Information
Which instrument(s) are you interested in studying?*
Please indicate the musical genre you would prefer to study, if known
- Classical music
- Contemporary genres (jazz/folk/pop/musical theatre)
- No preference/don’t know
Name of preferred instructor(s) (if known)
Previous instructor(s) (if applicable)
What is your past musical experience?
Briefly describe your musical goals
Which location would you prefer?*
- Downtown Victoria (900 Johnson Street)
- Westhills, Langford (210 - 1314 Lakepoint Way)
- Either
I would like to have online lessons
Please note the location is still required even if online lessons are preferred.
Availability
Please 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 list
Availability (1 of 4)*
Availability (2 of 4)*
Availability (3 of 4)
Availability (4 of 4)
ADDITIONAL INFORMATION (use this space to supply any further details that may assist us in assigning the instructor that will suit you best)
Pricing Information
TUITION: 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-info
Please indicate any financial restrictions for appropriate placement

Referral Form – Individual Lessons

Student Referral Form

Contact Information

Musical Interest Information

Availability

Pricing Information