Instrument Repair Request
Complete this form so that we can make arrangements for your instrument to be repaired. If you are unsure what to write, talk to Mr. Smith in class as we can figure out what the issue might be.
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* Required
Student Name
*
Your answer
Class Period
*
Choose
1 Period
2 Period
3 Period
4 Period
5 Period
6 Period
Instrument
*
Choose
Flute
Clarinet
Bass Clarinet
Alto Saxophone
Tenor Saxophone
Baritone Saxophone
Trumpet
F Horn
Trombone
Euphonium
Tuba
Percussion
Instrument Locker Number / Instrument Location
*
Your answer
Where did you get your instrument?
*
Music & Arts (formerly Draisen-Edwards)
Dave's Music
Chick Music
Personal instrument / Purchased elsewhere
School Instrument
Other:
In your own words, what problem are you having? For example, which notes don't play, is a certain valve always getting stuck, etc.
*
Your answer
Did something happen that might have caused the issue? This helps us troubleshoot the problem.
*
Yes
No
Not sure
If you answered yes, explain what happened:
Your answer
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