ISD Instrument Loan-out Agreement

I agree to accept the responsibility for the care of the school instrument being loaned to my son/daughter _________________________________, for use in the orchestra class at Pine Lake Middle School.

I understand that the loan fee of $75 per school year (which can be made in 3 trimester payments) covers maintenance (i.e. bow rehair due to regular use, string repair, etc.) of the instrument for the year. I understand that my student is to keep the instrument in good playing condition and will report any problems to the Director. I will arrange and pay for the repair of any damage or breakage for which my child is responsible.

Parent's signature_________________________________________

Address______________________________________________

Phone___________________ Date_______________

Please make checks payable to Pine Lake Middle School. Payment for the entire year is preferred, however,$25.00 per trimester is available.

School use only

Instrument: ________________________________________

Serial Number:______________

Accessories: bow___ case____ rosin____ end-pin holder____

Approximate value:$__________

Date Loaned_______ Condition_______________________________init.___

Date fee paid________

Date returned _________Condition_____________________________init.___