Clovis Unified School District - Instrument Loan Agreement

Clovis Unified School Districk | Clark Intermediate School 902 5th Street Clovis, CA 93612 | 559-327-1609 | e: christopherwatson@cusd.com
Instrument Loan Agreement

This is an agreement form between the named person using the instrument and Clovis Unified School District. By signing below, I agree to the loan of this property to the student listed. I agree to see that it is properly cared for and maintained. I further agree that said instrument is received in good working order. In the event that the instrument or any accessory is damaged, lost, or stolen, I agree that I am financially responsible and will be required to pay Clovis Unified School District for the full cost of repairs or replacement as per Education Code 48904. The assessed value and/damage shall be determined by Clovis Unified School District and a reputable repair agency. I further agree to return this instrument at any time upon request of the school.
Music Teacher*

First NameLast Name
Student Name*

First NameLast Name
Parent Name*

First NameLast Name
Date*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Parent Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Instrument Needed
Instrument Information (To be filled out by Music Teacher)

Instrument Type

Additional Accessories

MakeSerial Number

Replacement Cost $
Parent Signature*

Clear
Signing this document you are agreeing to the terms and conditions laid out by Clovis Unified School District regarding the rental of the instrument.
Date Signed*

MonthDayYear
Date
Should be Empty: