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DSF Instrument Sign-Out Agreement (2023-2024)
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* Indicates required question
Student Name
*
Your answer
Student Email
*
Your answer
Instrument
*
Choose
Piccolo
Flute
Oboe
Clarinet
Bass Clarinet
Bassoon
Soprano Saxophone
Alto Saxophone
Tenor Saxophone
Baritone Saxophone
Trumpet
Flugelhorn
Mellophone
French Horn
Trombone
Marching Baritone
Baritone/Euphonium
Tuba
Marching Tuba
Marching Snare Drum
Marching Tenor Drums
Marching Bass Drum
Violin
Viola
Cello
Bass (upright)
Bass (electric)
Guitar
Other
If you selected "Other" please indicate the instrument here:
Your answer
Make/Model
*
Your answer
Serial Number
*
Your answer
HCPS ID Number (if any)
Your answer
Accessories
*
Case
Mouthpiece
Cleaning Cloth or Cleaning Swab
Lead Pipe (baritones and tubas)
Bow (strings)
Rock Stop (strings)
Shoulder Rest (violins/Violas)
Other:
Required
If you selected "other" above, please list any accessories.
Your answer
Parent/Guardian Name
*
Your answer
Home Street Address
*
Your answer
City/County
*
Your answer
Zip Code
*
Your answer
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