Instrument Loan Agreement

Year-Round Schools


I, __________________________, accept full responsibility for _________________________,
(Parent) (Description of Instrument)

________________________ and accessories _______________________________________
(Serial Number) (Please list - mouthpiece, bow, case, etc.)

loaned from the Wake County Public School System (WCPSS) for use of my child,

__________________________ during the ____________school term. I understand the value of

the instrument and accessories loaned to me is $_____________________.

I agree to care for the instrument and accessories as if they were my own and to pay for any
damage made necessary by misuse, negligence, or carelessness as determined by the schools
instrumental music teacher. Under no circumstances will I attempt to repair or have it repaired
without permission from the Arts Education Office. I will be responsible for the total cost of
repair to a damaged instrument. If the instrument is lost I agree to pay the minimum fee of
$250.00.


________________________________ ________________________________
(Student Signature / Date) (Parent/Guardian Signature / Date)

___________________ ____________________
(Grade) (Track)

________________________________________ __________________________
(Address) (Phone)

_________________________________ ______________________________
(School) (Teacher)


The instrument listed above has been returned.

________________________________ _________________________________
(Student Signature / Date) (Teacher Signature / Date)



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