PUSD INSTRUMENT USE AGREEMENT
Please fill out this form, read the agreement carefully, sign it, and have your parents sign it. Thanks! Ms. Brown, Mrs. Hardee, and Ms. Smith.
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Email *
Student First and Last Name *
School *
Grade in school *
Band Teacher/Classroom Teacher *
Parent / Guardian Name *
Physical Address *
Mailing Address
Parent/Guardian Phone Numbers (Work/Home/Cell) *
Student Email *
Parent / Guardian email(s) *
Instrument(s) you will be borrowing from the school this year:
Please list each instrument with its case number, brand/model, and serial number here:
Please describe the condition of the instrument and case here:
Accessories (mouthpiece, ligature, cleaning equipment, mask/bell cover, mutes, neckstraps, etc.)
By Signing You Agree:  1) The instrument will remain the property of Plumas Unified School District and must be returned on or before the last day of school (or the last day of enrollment, if applicable).  2) The student will maintain the instrument in the same or better condition as it was when issued. Student is responsible for routine maintenance such as oiling valves, greasing corks & tuning slides, swabbing out the instrument after use, etc..  3) If instrument becomes damaged or unplayable, student or family will immediately notify teacher.  4) Repairs MUST only be performed by a qualified instrument repairman, pre-approved by the music instructor.  5) Music instructor can revoke this agreement at any time due to lack of proper instrument care--at which time student or family will immediately return instrument to the school, as instructed. *
PARENT SIGNATURE:   I have read the terms of this agreement, above, and promise to ensure the instrument will be well-cared for and returned, as stated. In the case of damage or loss, I promise to notify my music teacher or the school secretary immediately. (State "I agree" and sign your full name) *
STUDENT SIGNATURE:   I have read the terms of this agreement, above, and promise to ensure the instrument will be well-cared for and returned, as stated. In the case of damage or loss, I promise to notify my music teacher or the school secretary immediately. (State "I agree" and sign your full name)
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A copy of your responses will be emailed to the address you provided.
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