Use of Musical Instrument Form
FULTON COUNTY SCHOOLS - ALPHARETTA HIGH SCHOOL

I, the undersigned, agree to the conditions set forth by the Fulton County Music Education Department regarding the use of a school-owned instrument during the school year:

1. Yearly payment of $25 for the use of the string instrument outfit (instrument, case, bow). Payment of this contribution is not a requirement for acceptance into the instrumental music class, but is necessary for home use of the instrument.
2. Assumption of the responsibility for any major repairs incurred during the time the instrument outfit is being used by the student.
3. Replacement of the instrument outfit (at school district cost) if it is lost or stolen. Another instrument cannot be issued until the missing one is replaced.

Email address *
Student's First Name *
Your answer
Student's Last Name *
Your answer
School
Home Street Address *
Include apartment or unit number, if applicable.
Your answer
City *
Your answer
Zip Code *
Your answer
Parent Phone 1 *
Your answer
Parent Phone 2
Your answer
Student Cell Phone *
Your answer
Parent Email Address
Your answer
Instrument Type *
Brand *
Your answer
Model # *
(Not the same as the serial number)
Your answer
AHS Instrument # *
(Ex: Violin #4)
Your answer
Serial # *
(Will be on the inside of the instrument)
Your answer
FCS Barcode #
(Will be a sticker on the side)
Your answer
The instrument outfit includes: *
(Check all that applies)
Required
I have read the information above and will take care of this instrument as if it were my own. I understand that if the instrument is lost, stolen, or broken that I am financially responsible for its replacement (at school price). *
Required
A copy of your responses will be emailed to the address you provided.
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