TLU CMA INSTRUMENT RENTAL AGREEMENT FORM
Please complete a separate form for each instrument that you are renting.
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Student Last Name
Student First Name
Class Student is Enrolled In - check all that apply
Patlan, Mon Level 1 Violin Class
Rodriguez,Tues. Level 1 Violin Class
Outreach Level 2 Violin Class
Koennecke, Tues. Level 1 Cello Class
Guitar Outreach Class Level 1
Guitar Outreach Class Level 2
Small Group Violin/Viola/Cello Class
Instrument you are renting
Instrument size (if known, should be on instrument case). Otherwise, leave blank.
Instrument Number (Should be on instrument case). If unknown, leave blank.
Parent/Guardian Last Name
Parent/Guardian First Name
Parent/Guardian phone number
Home mailing address
By clicking below, I am indicating that I am responsible for paying for loss or damage to this instrument. I also agree to inform my instructor or the director of any problems with the instrument when they occur, and to return it clean, with accessories when requested. If we need to discontinue the class at any time, I agree to return the instrument to the instructor.
I agree and accept
I have indicated below how I am paying the instrument rental fee of $20:
I am paying the fee now with my registration
I will go to the website to pay
I have already paid the instrument rental fee online at
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