CMS School Instrument Rental Application

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-Only complete this form if school instrument is needed. This does not guarantee that you will receive an instrument. This lets Mr. Jacques know that you would like an instrument from the school. The rental fee is $100, with payment plans available if needed. Please understand that the school has limited instruments available. Large or less common instruments are available to rent from the school without being in financial need. These include: oboe, bassoon, bass clarinet, tenor/bari sax, French horn, trombone, baritone/euphonium, tuba and percussion kits.

-Complete this form by Wednesday, August 21st at 2:30pm to be considered for a school rental. DO NOT SEND IN MONEY UNTIL THE RENTAL IS APPROVED AND YOU RECEIVE A RENTAL FORM.

Student First Name *

Student Last Name *

Student Grade *

6th Grade

7th Grade

8th Grade

Band Class *

3rd Period Concert Band

4th Period Advanced Band

5th Period Intermediate Band

6th Period Beginning Band

7th Period Beginning Band

Instrument Requested *

Flute

Oboe

Bassoon

Clarinet

Bass Clarinet

Alto Sax

Tenor Sax (must participate in jazz band)

Bari Sax (must participate in jazz band)

Trumpet

French Horn

Trombone

Baritone

Tuba

Percussion Kit

Parent/Guardian Email *

Student receives free/reduced lunch: *

Yes

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