Instrument Use Agreement

Student Name

Instrument

Make

Model

Serial Number

Accessories

Condition

Cary Academy is responsible to provide:

1. Instrument

2. Preventive maintenance and repairs made necessary due to normal use

Students and Parents are responsible to provide:

1. Supplies needed to play and maintain the instrument properly

2. Repairs necessary due to accident or negligence

Student Signature Print Name Date

Parent Signature Print Name Date