Secaucus Community Education
On-Line Registration Form

Fill in the blanks below to register online. All blanks with an asterisk (*) must be filled in to ensure proper registration.  ONLY ONE STUDENT per registration form. You may register up to three (3) courses on one on-line registration form.  Remember, registration online DOES NOT guarantee your seat in a limited class selection.  Payment MUST be made at the Secaucus Adult School or mailed prior to the beginning of classes to ensure position in all limited classes (Please read the Registration Information located on the Secaucus Adult School's Home page for more details). A confirmation notice of your completed registration form is given after clicking the submit button below.  It is advisable for you to print this confirmation notice for your personal records.

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First Name:*
Last Name: *
Address:*
City: *, State: Country:

Email: (optional)
Phone #: *
Other Phone #:

Course 1 #: *  Title 1: *  Fee 1: $
Course 2 #: *  Title 2: *  Fee 2: $
Course 3 #: *  Title 3: *  Fee 3: $
                                                                                       Your Total: $

Comments:

*