Instrument Checklist Form

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This form is to be completed by your tutor and submitted on or before the Instrument Return/hire Day on Monday 16th December 2019, 3:15pm- 5:30pm in the 1891 building. NB: A completed form is required to re-hire an instrument for 2020.

Tutor Name: *

Student Firstname:

Student Lastname: *

Instrument Type (& size if applicable) : *

Instrument Serial No (If on tag) :

Instrument Condition: *

Perfect Condition

Reasonable condition

Old but still ok

Needs to be retired in the next 12 months

Can't be re-hired and needs to retired now

Required

Are there any repairs required? (Provide details)

Does the instrument need a service? *

Yes

Required

Is this instrument in a suitable condition to be re-hired as is?

Yes

CASE DETAILS: Instrument Case No (If on tag):

Does the case have LCPS contact details? *

Yes

Required

Does the case have a child’s name? *

Yes

Required

Are there any repairs required to the case? (Provide details).

Is this case in a suitable condition to be re-hired? *

Yes

Required

FOR VIOLIN, CELLO & GUITARS ONLY: If student requires a larger instrument which size do you recommend?

Note for parents: If you are returning an instrument you (the parent) will be asked to complete a bond refund request form. This will be paid once the instrument has been returned in good condition. The form can be found at: https://forms.gle/AMAq1YiCnuPaZmot7.

Option 1

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