Lesson Request Form

Fill out this form if you would like us to contact you regarding lessons at the Ted Herbert Music School & Rentals. Please note that we will contact you within 2 business days; if you do not hear from us please contact us at (603)669-7469 or email karen@majestictheatre.net so we can accommodate your request in a timely manner.

How may we help you?

Please specify any questions here:

Have you read "How It Works" on our site?

Please do so before submitting this form.

Student Name

First Name

Last Name

Student Date of Birth

YYYY

Parent/Guardian Name

Parent Information is only needed if student is under the age of 18.

First Name

Last Name

Phone

(###)

###

####

I would like lessons in:

ONE INSTRUMENT / COURSE OF STUDY ONLY PLEASE. Please complete separate request forms for multiple students.

Have the student taken lessons in the past?

If YES, with whom and where?

Please select one:

Beginner

Intermediate

Advanced

If you are Intermediate or Advanced, how long have you been playing?

Do you have your own instrument?

If ACTING or VOICE, click YES :)

How did you hear about us?

Best Days/Times for lessons:

Please note that your flexibility will allow us to pair you with a teacher more easily.

Did a current Ted Herbert student refer you? If so, what is their name?

Any other comments, questions, or considerations you would like us to know about?

Lesson Request Form

Thank you for your interest in lessons at Ted Herbert’s. We typically respond within 24 hours; if you don’t hear from us within 2 business days please contact us here.

We are looking forward to making music with you!