FCM Student Renewal Form | Fairfax Conservatory of Music

Student(s) First Name(s): If Multiple Family Members, list all names

Last name

Email

Phone

Emergency Contact Person and Phone #

Do you require any changes to your plan for the new academic year?

Instrument & Lesson Duration: List for Each Child/Adult Student (30, 45, 60mins, or 75mins+) For Example: Lilian, Piano 45mins. James, Voice 30mins

Do you Wish to Keep Your Schedule the Same as Last Year?

If You Require a Schedule Change: Please List at least 3 Different Days/Time-Frames of your Current Availability

Lesson Start Date

Select All of Interest

Youth Lessons (Age 4-17)

Adult Lessons (Age 18+)

Custom/Drop-In Lessons

Master Mentorship Lessons

Music for Littles (Age 3-4)

Group Ukulele/Guitar Class (Age 5-9)

Beyond Singing: Group Voice Classes (Age 6-11

Group Keyboard Skills/Musicianship for Music Production (Age 12+)

Tune Into Baby: Parent & Baby Music Enrichment Class

Future Summer Plans

I authorize FCM and any of its agents/employees to take my/my child's photo, video, or audio recording for marketing and/or publication (online, or otherwise).

I acknowledge that I must give a minimum of 24 hours notice when cancelling or rescheduling a lesson, otherwise the lesson will count as fulfilled.

I acknowledge that my tuition is paid in equal installments each month for lessons in the Academic Year. The installment amount does not change despite absences or vacations. I understand a tuition installment is not for 4 lessons a month.

I have read the Current FCM Student Policies and agree to the terms and conditions.

Signature

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Today's Date

Current Student Renewal Form for 2025-2026