Instrument Loan Agreement
I understand that this is a musical instrument loaned to my child as a courtesy by the school district. I
assume responsibility for this instrument and will comply with the following:
1. This instrument must be kept in a safe place.
2. The instrument must be brought to the music teacher for repairs if the instrument is not
playing properly. I SHALL NOT ATTEMPT REPAIRS ON MY OWN. If the instrument is
damaged, as the parent/guardian, I am responsible for the cost of the repairs to the
3. At the end of the school year, or in the event that I should move within the district or out of
town, the instrument must be returned to the music teacher.
4. If the instrument is lost, stolen, damaged beyond repair or not returned, I will be held
responsible for paying for the replacement of the instrument at current market value or
replacing it with one of equal quality.
5. All property of the District shall remain the property of the District.
According to California State Education Code #48904 and SBCUSD Board Policy #3204:
"The parent or guardian of a pupil shall be liable to a school district for all property
belonging to the School District loaned to the student and not returned upon demand of an
employee of the District authorized to make the demand. The grades, diploma, and
transcripts of the pupil responsible for the damage, or property not returned shall be withheld
until restitution is made."
Failure to pay will result in legal action
Period 2: Concert Band
Period 3: Jazz Band
Period 4: Chamber Orchestra
Period 5: Music Appreciation
Period 7: Guitar
Period 8: Marching Band
Student First Name
Student Last Name
Student ID Number
Parent E-Mail Address
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This form was created inside of San Bernardino City USD.