Albuquerque Public Schools Instrument Loan Agreement 2020-2021 School Year-Desert Ridge Middle School Orchestra
School Instrument Use form for Desert Ridge Middle School Orchestra Students. If you use more than one school instrument, you must fill out a form for each school instrument you use.  
Sign in to Google to save your progress. Learn more
Student and School Information
Today's Date *
MM
/
DD
/
YYYY
School Location *
Student Last Name *
Student First Name *
Student ID Number *
What is the student's email address? *
What is the parent/guardian's email address? *
Orchestra Class *
Contract Dates *
Instrument Information
Instrument *
Instrument Size *
Instrument Brand (Located inside the instrument) Describe as best you can. *
Describe the general condition of the instrument *
What is the APS Serial Number of the instrument? This can be located in a couple places-carved on the bottom of the instrument, on the scroll, inside the instrument. Please see the photo for an example. Most serial numbers start with "APS430MR" and a 5-digit code. If you are not sure, write down what you can find. *
Captionless Image
What is the factory serial number of the instrument? (Leave blank if you cannot find one)
The Following Terms Are Agreed to By the Student, Parent/Guardian, and Director:
Please select "We Agree" to the following statements. You must agree to all of the statements in order to use a school instrument.
Student and Parent/Guardian acknowledge receipt of the instrument above on (enter the date you received the instrument) *
MM
/
DD
/
YYYY
Student and Parent/Guardian agree to pay rental fees, if any, required by the school. The fees for using a school instrument is $40/semester. If you choose to pay for a year in full, the cost is $75. If the school instrument is a second instrument, the cost is $15 per semester. A fee waiver or reduction may be requested. *
Student and Parent/Guardian accept full responsibility for any damage to or loss of this instrument while in his/her possession. *
Repairs due to normal wear on the instrument as determined by the APS music instrument repair technicians will be the responsibility of APS. Repairs due to any other type of action will be the responsibility of the Student and Parent/Guardian according to the replacement cost determined by the APS Fine Arts Department.  This includes accidental damage. *
Lost instruments will be replaced by the parent/guardian according to the replacement cost determined by the APS Fine Arts Department. *
Student agrees to return the instrument when asked to do so by his/her director. *
The instrument will not be taken outside of Albuquerque unless authorized by the director. *
Signatures and Acknowledgment of the Instrument Loan Agreement
Please type the student's full name below as a signature. *
Please type the Parent/Guardian's full name below as a signature. *
Please fill out the home address where the instrument is most likely to be kept. (This information will not be shared) *
What is the phone number of the parent/guardian? (this information will not be shared) *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Albuquerque Public Schools. Report Abuse
Google Forms