Jordan School District



Jordan School DistrictMUSICAL INSTRUMENT RENTAL/USE AGREEMENTThis Form must be appropriately completed BEFORE the instrument is rented PLEASE PRINT in INK*School: _____________________________________________________ *Date: ____________________________*I, (Parent)__________________________________________________________, hereby acknowledge the receipt for my student, ____________________________________________________, to rent the following instrument for $80.00, from Jordan School District, for the school year:Instrument: ____________________________________Make: ___________________________Serial Number: _________________________________________Parents, please read and discuss the following statements with your student, then initial each statement to establish your agreement and responsibility of the said instrument. ____________ I pledge to preserve the said musical instrument and accessories (case, lyre, mouthpiece, etc.) in their present condition at any and all times and to return the said property to the above mentioned school in the same condition as when received (normal wear to be allowed). _____________Any expenses necessary to restore the said instrument or accessories to their original condition or to replace the same, in the event of it loss, are to be borne by the student and responsible parent or guardian renting the instrument.____________No person, other than the above student, will be allowed to handle or use the instrument without the consent of the music instructor. It is agreed that every precaution will be taken to insure that other students do not use the said instrument.The condition of the said instrument is as follows: (major dents, cracks, or other deficiencies that may exist on the instrument or case (including locks, etc.).______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Student Signature of Agreement: __________________________________________________________________________Parent/Legal Guardian Signature of Agreement: _______________________________________________________Today’s Date: _________________________________ ................
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