Cobb County School District

Check-out Form for School-Owned Musical Instruments

Name ______________________________ Instrument______________  Brand ____________________

Serial Number ____________________  School’s Number ________________   Value _______________

Accessories:

                                ____________ Case                                          _____________ Neck Strap

                                ____________ Bow                                           Other ____________________________

WE ACKNOWLEDGE RECEIPT OF THE ABOVE INSTRUMENT AND ACCESSORIES AND WE AGREE TO THE FOLLOWING:

1.         To be personally responsible for the safe-keeping of this instrument and return it immediately to the school upon request of the director or Principal.

2.         To maintain the instrument in good condition at all times including having it repairs as deemed necessary and as requested by the director.  (Any repairs which are to be paid by the school must be handled by the Band or Orchestra Director.)

3.         To have the instrument assessed by the teacher at the end of the contract period and pay a fair assessment for all damage in excess of normal wear and tear.

4.         To allow no person other than myself to play, handle or use this instrument without specific permission of the director.

5.         To use the instrument to the best of my ability for serious study including regular attendance at all organizational rehearsals and performances, regular home practice and additional instruction and study when possible.

____________________________________                      _______________________________________

Signature of Parents or Guardian                                               Name of Student

 ____________________________________                      _______________________________________

Address                                                                                    City                      State                    Zip

_____________________________________                    _____________________________________

Home Phone                                                                             Business Phone

This form must be signed and returned before the instrument is released to the student.   It will be kept on file until the instrument is checked in.

TO BE COMPLETED WHEN THE INSTRUMENT IS CHECKED IN:

The above-named instrument has been returned in satisfactory condition.

 Date _________________                         Signature of Director __________________________________