Instrument Loan Form 2016-2017
Balfour Area Elementary Band
Student Name
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Parent/Guardian(s) Name
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School:
Grade:
Instrument:
Payment Options: Please select how you will be paying the rental fee.
Other Payment options: You are welcome to pay the $120 at once or pay monthly. Please indicated your preferred payment plan:
I take responsibility for the care of the band instrument which will be loaned to my child for the 2016/2017 school year. I accept all responsibility for damage to, or loss of, the instrument. I have discussed with my child the importance of carefully transporting and caring for his/her assigned instrument. The loan fee for the 2016/2017 school year is $120.00, due and payable prior to the release of the instrument. It is preferred that all payments be made online. Refunds will only be granted before October 31, 2016 and will be adjusted for services provided. Please note that payment plans are also approved by the school board. PLEASE ENTER YOUR FULL NAME HERE. This will be your electronic signature agreeing to the above terms of rental.
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