Financial Assistance Instrument Loan Form 2016-2017
Balfour Area Elementary Band

I have contacted St Johns Music and Long and Mcquade music in Regina and have determined that I am not able to cover the cost of an instrument rental for my child at this time. I am completing this instrument loan form so that I can borrow an instrument from the school board for the 2016-2017 school year.

Student Name
Your answer
Parent/Guardian(s) Name
Your answer
School:
Grade:
Instrument:
Optional payment plan: The school board is able to provide your instrument at no charge...however you can also choose to pay any amount that you are able to. This money will be used towards the cleaning, repair, and purchase of instruments for inventory that the school board provides to low income families.
If you selected to pay a lump sum or monthly amount, please indicate the amount you will be paying:
Your answer
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. PLEASE ENTER YOUR FULL NAME HERE. This will be your electronic signature agreeing to the above terms of rental.
Your answer
Submit
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