Instrument Usage Form
For use of a Plano ISD Instrument in the Murphy MS Orchestra ***Due by the end of week 6***
Email address *
The Plano Independent School District
The Plano Independent School District provides certain musical instruments. A non-refundable $85.00 instrument maintenance fee is charged to maintain the normal wear and use of this instrument for the school year. Students who use multiple instruments in the normal course of instruction will pay a single fee. Pay online using Paypams at this address:
Parents agree to return the instrument to the director at the end of the semester or academic year, or upon director request, in the same condition it was issued to the student, less reasonable wear. The maintenance fee does not cover major damage or loss. Damage beyond normal wear or loss of the instrument while in the student’s possession becomes the responsibility of the parents to pay for repairs or replacement.
If the instrument is to be taken home, the Plano ISD encourages parents to cover these instruments on their homeowners’ insurance policy if possible. Alternative insurance policies are also available at a nominal annual fee. Please see your director if interested. Please sign below to state that you have read and agree to the terms of this contract.
Student First Name *
Your answer
Student Last Name *
Your answer
Parent Name *
First Last
Your answer
Instrument *
PISD Item Number *
(ex. 144) PISD # found in gradebook
Your answer
Orchestra Class *
PAYPAMS Code: (please choose "Orchestra") *
This code is a receipt of payment and is provided to you once the PAYPAMS transaction is complete. choose Instrument User Fee "Orchestra" ($85.00)
Your answer
Electronic Signature Authorization *
I agree that the electronic digitized signatures I apply on this document are representations of my signature and are legally valid and binding as if I had signed the document with ink on paper in accordance with the Uniform Electronic Transactions Act (UETA) and the Electronic Signatures in Global and National Commerce Act (E-SIGN) of 2000.
A copy of your responses will be emailed to the address you provided.
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