I, __________________________, accept the following responsibilities of using a school owned instrument:
· Keep the instrument clean and in working order (You pay for cleaning supplies)
· Report any mechanical or cosmetic problems to band director ASAP
· Cost of repairs that are non wear and tear or preventable items (ex. Instrument is dropped and breaks, or is broken because of misuse, lost or stolen from an unacceptable location, or is damaged while left in an unacceptable location.)
Instrument: __________________________________________________
Make: __________________________________________________
Model: __________________________________________________
Serial#: __________________________________________________
Address: __________________________________________________
__________________________________________________
Phone Number: __________________________________________________
Student Signed: __________________________________________________
Date: __________________________________________________
Parent Signed: __________________________________________________
Date: __________________________________________________