VCM Referral Form
Please fill out and submit the following information and a VCM staff member will contact you with scheduling and instructor information.
CONTACT INFORMATION
Today's Date
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Requested Start Date
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Student First Name
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Student Surname
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Date of Birth
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Phone Number
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Email Address
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Street Address
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City
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Province
Postal Code
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Postal Code
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Parent/Guardian/Payer Name (if different from student):
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Phone Number
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Email Address
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Preferred Contact Method
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Payer Street Address (if different than student)
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City
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Province
Postal Code
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Emergency Contact
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Phone Number
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Email Address
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Relationship
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MUSICAL EXPERIENCE
What instrument(s) are you interested in studying?:
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Name of preferred instructor(s) (if known):
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Have you taken lessons before?
If so, for how long?
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Do you read music?
Previous instructor(s) (if applicable):
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Briefly describe any past musical experience and your musical goals:
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How did you hear about the VCM?
AVAILABILITY
Please indicate up to 3 lesson time ranges (i.e. weekdays after 5:00pm; anytime on Saturday) that will work best for you, in order of preference.
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Preferred Lesson Length (if known, i.e. 30, 45, or 60 minutes):
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Which location would you prefer?
PRICING
FEES: There is a $2 fee applied to each registration transaction.

REFUND and WITHDRAWAL POLICIES: please consult http://vcm.bc.ca/the-fine-print/

PAYMENT OPTIONS: VCM accepts cash, debit or cheque payments for individual lesson tuition. Credit card payments are accepted for group class tuition, fees, and merchandise only. Monthly payment options are available, via post-dated cheques or automatic withdrawal.

Individual and shared lessons are available in four fee groups, depending on the experience of the instructor and the level of the student. Rates are $51, $61, $71 and $81 respectively. Please indicate any financial restrictions for appropriate placement:
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ADDITIONAL INFORMATION (use this space to supply any further details that may assist us in assigning the instructor that will suit you best).
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