2022-2023 Instrument Check-Out Form

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Email *

8/15/2022 *

YYYY

Name of Student checking out instrument *

Instrument being checked out: *

Make and Model of Instrument being checked out.

Example: Yamaha Y-123

Serial number of instrument being checked out *

Accessories: *

Case

Mouthpiece

Neck Strap

Ligature

Mouthpiece cover

Option 6

Required

By typing student name and parent name you agree to the following:

1. You are responsible for the cost of repairing any damage that occurs while instrument is checked out to you.

2. You will return the instrument in the condition that it was issued to you.

3. You are responsible for proper care of instrument and will not allow other students to use it.

4. I will return instrument upon request from any Dale Band Director or Dale administrator.

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