2175 Lemoine Ave, #503

Fort Lee, NJ 07024

201-970-7500

We strive to inspire every student to reach their full potential through our teaching motto — "Where Fun Meets Challenging!"

Registration Form

1. Student Information

Student Name

Additional students (siblings) can be added below

First Name

Last Name

Child

Adult

Birthday

Adult students can skip this question by entering today's date.

YYYY

Instrument

What instrument is the student interested in learning?

Referred by

How did you find us?

2. Primary Contact Information

Name

Parent, Guardian, etc

First Name

Last Name

Relation to student

Mother, Father, Grandmother, Grandfather, etc.

Phone

(###)

###

####

Texting Ok?

Home Address

3. Second Contact Information

Name

First Name

Last Name

Relation to student

Mother, Father, Grandmother, Grandfather, etc.

Phone

(###)

###

####

Texting Ok?

5. Additional Information

By submitting this form you acknowledge that you have read and understand Fort Lee School of Music's lesson policy

Today's Date

YYYY