Instrument Loan Request Form
The Music Department of the Bergenfield Public Schools has a limited number of school-owned instruments available for loan to students. District-owned instruments will be available to those pupils for whom the purchase of a musical instrument would impose a difficult financial burden. A list of music stores with rent-to-own programs is provided by the instrumental music faculty.

School-owned instruments are being offered in the fall 2022 to students in grades 4-12. Completion of this form does not guarantee the instrument will be available. School instruments will be distributed until the supply is exhausted on a first-come, first-served basis. Instruments must be returned at the end of the school unless other arrangements are made with the instrumental music faculty.

Please note that the repair of damage caused to school-owned instruments is the parents' financial responsibility. If there is damage to an instrument, you must contact Dr. Brian Timmons ( or Dr. Stacey Sassi ( before getting the repairs done.
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Student First Name *
Student Last Name *
Student ID Number *
Student Grade *
Current School Attending *
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