Eureka Springs School - INSTRUMENT RENTAL FORM

Eureka Springs Instrument Check Out Form

Please Fill Out The INSTRUMENT RENTAL FORM Below

Name of Student

Select Your School

High School

Middle School

Instrument

Instrument Brand

Serial Number

Instrument Replacement Value

Condition of Instrument at Checkout/Check In

Excellent

Good

Fair

Poor

Date of Check Out

Date of Check In

Parent/Guardian Name

Home Residential Address

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Student Promissory Note of Care for Instrument

I understand that I am responsible for the care and safe-keeping of this instrument. I also understand that I must return this instrument to the school on the last day of classes for the quarter I am using it. Failure to do so will result in a late fee as set by the school board.

Student Signature

Date of Signature

Parental/Guardian Note of Responsibility/Liability of School Owned Instrument

I understand that my child is responsible for the care and safe-keeping of this instrument. I also understand that I must return this instrument to the school on the last day of classes for the quarter I am using it. Failure to do so will result in a late fee as set by the school board.

Parent/Guardian Signature

Email a copy to

optional

Required Fields

Band & Choir Navigation

Notification Center

Current Weather

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Temperature: 39.29˚F

Feels Like: 32.34˚F

Wind Speeds: 5.3mph

Weather humidity: 67%

Chance of Precipitation: 0%

Contact Barry Milner

Classroom Number:
HS BAND

Conference Time:
After School (3:05-5:30)

Email:
bmilner@es.k12.ar.us