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Little Rock School District
School-owned Instrument Contract Receipt
Email *
School/ campus *
Instrument: *
Brand name:   *
Serial number (set of numbers and letters etched on the instrument somewhere) *
Condition   *
What came with it?  (list other items in the case such as mouthpieces, valve oil, slide grease, etc. ) *
Case number
Name of Student: *
Address: *
Parent/ Guardian's Name: *
Parent/ Guardian's Phone number: *
We, the undersigned student and parent (or guardian) hereby acknowledge receipt of the instrument listed above from the Little Rock School District and further agree: 1. That the instrument is and will remain the property of the Little Rock School District. 2. That it will be returned to the school from which borrowed upon the request of the music instructor or principal. 3. That we will endeavor to keep the instrument from being damaged.  It will be returned to the school in the same condition as received.  Any exception must be granted by the music instructor or principal.  (Student digital signature) *
Type your child's band director's name. *
Parent's name: *
Date received: *
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