SCHOOL INSTRUMENT USERS ONLY! You will know if you need to fill this out!

School instruments are for daily, home, and concert use and are intended for students who are unable to easily obtain an instrument from another source. Students wishing to use a school owned instrument must fill out this form. Parents/Guardians assume the responsibility for any major repairs incurred during the time the instrument is being used by the student. Parents/Guardians also agree to replace the instrument (at school system cost) if it is lost or stolen. Another school owned instrument cannot be issued for home use until the missing one is replaced. The maintenance/usage fee is $70 per year.

Students Name *
Students Name
Address *
Address
Home Phone
Home Phone
Parents Cell or Work # *
Parents Cell or Work #
By checking below, I hereby acknowledge the receipt of the above-named equipment. I understand that this equipment is the property of the Taylor Road Middle School Band and Fulton County. I also understand that I am receiving the equipment in good working order (unless otherwise stated above). I also acknowledge the Fulton County Band and Orchestra Voluntary Instrument Usage Fee of $70/year payable to Taylor Road Middle School. I further understand that I must return the instrument in good condition in the event of relocation or at the end of the school year. *