Online Registration Form

Ready to register for lessons? You may use this convenient online form. We will follow up with an invoice and instructions on paying by check or via PayPal.

Online Registration Form

Please read the Lesson Policy and Fee Schedule, fill out one form for each child, note your agreement to the terms below, then submit the form. After your registration is processed, you will receive an e-mail with the invoice and instructions on how to pay (check or PayPal.)

Child's Name *

Date of Birth *

Type date or select from calendar

Grade *

Contact Name (Parent/Guardian) *

Contact Phone *

Phone Type *Home PhoneWork PhoneCell Phone

Contact Address *

Email Address *

Alternate ContactPerson to contact if you cannot be reached

Alternate Phone

Phone TypeHome PhoneWork PhoneCell Phone

About My ChildPrevious musical instruction, student's strengths/challenges, learning styles, goals, etc.

CommentsAdditional information is welcome.

My Child is Interested in: *Piano LessonsViolin LessonsOther (please specify at right)

Other Lessons Desired

Preferred Location *Journal Square VicinityLincoln Park NeighborhoodDowntown Jersey CityCheck all that apply

Preferred Lesson Day *MondaysTuesdaysWednesdaysThursdaysFridaysSaturdaysSundaysCheck any days that work with your child's schedule

Agreement *I have read and understood the My Music Garden Lesson Policy and My Music Garden Fee Schedule and I agree to the terms and conditions.<p align="center"><a href="lesson-policy" target=_blank>View Lesson Policy</a> <a href="calendar-and-fees/2" target=_blank>View Fee Schedule</a></p>

Date Submitted *

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