School Instrument Contract - St. Louis Public Schools



Carr Lane VPA, St. Louis Public Schools

School Instrument Contract

Date: ______________________

Student Name __________________________________ Grade _______________

Name of Parent Or Guardian : __________________________________________

Address: __________________________________________

___________________________________________

Phone #: ______________________ __________________

(Home) (Cell)

Instrument: ___________________________________________

Brand/Serial Number: ___________________________________

Date Checked Out: _____________________________________

Value of Instrument: ____________________________________

Condition of Instrument: _______________________________________________

_____________________________________________________________________________

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This agreement entered into by and between Carr Lane VPA Middle School, the St. Louis Public School District and the person named above shall be binding upon same for as long as the instrument described above is on loan from the St. Louis Public Schools.

Upon signing this contract and receiving the afore instrument recorded on this document, the

said parent or guardian and pupil agree to the following:

1. To refrain from using the instrument in organizations, other than school, unless permission is received from the orchestra teacher.

2. To refrain from loaning or allowing any other person but the pupil to play or care for the instrument.

3. TO BE PERSONALLY RESPONSIBLE FOR ANY DAMAGE OR LOSS TO THIS INSTRUMENT WHILE IN YOUR CARE. IF THIS INSTRUMENT IS LOST OR STOLEN, THROUH NO FAULT OF THE ST LOUIS PUBLIC SCHOOL DISTRICT, YOU AGREE TO PAY A SUM TO REPLACE IT AT THE THEN CURRENT VALUE.

4. To pay for the repair of the instrument if it is damaged by pupil negligence.

5. To return this instrument to the orchestra teacher at Carr Lane VPA Middle School in the St. Louis Public School District in the same condition it was received (ordinary wear is accepted).

6. To return the instrument when the pupil is no longer enrolled in string classes or playing in a Carr Lane VPA Orchestra in the St. Louis Public School District.

We, the undersigned hereby acknowledge receipt of the instrument described in this document and have read, understand and agree to the above provisions. I also acknowledge that said instrument is and shall remain in the property of Carr Lane VPA Middle School and the St. Louis Public School District.

Parent or Guardian Signature ______________________________ Date ________________

Student Signature _______________________________________ Date ________________

Carr Lane VPA Middle School & St. Louis Public School District Representative

Signature ____________________________________________ Date ________________

(Guitar Class Teacher)

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