Folwell School, Performing Arts Magnet Music

Department
th
3611 20 Ave S. Minneapolis, MN 55407 (612) 668-4550

INSTRUMENT R ENTAL A GREEMENT F

ORM
Grade ____ Homeroom / Classroom (teacher name & room #)_____________________________

Student Name (print)______________________________ ID#______________

INSTRUMENT: ___________________________ SIZE ____________

MAKE:______________________________ SERIAL #_____________

ESTIMATED VALUE $__________CONDITION: NEW GOOD FAIR POOR
NOTES:

We agree to be responsible for the school instrument listed above. It is our responsibility to maintain the
current condition of the instrument and case listed above. We understand that repair due to natural “wear
and tear” of the instrument will be handled by Folwell. We also understand that any damage or loss
caused by misuse, abuse, or negligence on the part of the student will be the responsibility of the student
and / or parent / guardian.

There is a $40.00, non-refundable rental fee for the academic school year for each instrument rented. The
summer rental fee is $20.00. Make checks payable to Folwell School Band or Strings. Please put the fee
and contract form in an envelope marked with student name(s) and room number. Each child needs
his/her own contract. Please write checks separately for either the String Dept. or the Band Dept.
Instruments may not leave school until contract and deposit are received. If paying the entire fee at once
may be too imposing, contact your student’s instrumental teacher and a payment plan may be set up on an
individual basis.

Student Signature_____________________________________ Date______

Parent Signature______________________________________ Date______

Parent/Guardian #1`Contact Information

Name
Address
Phone
email

Parent/Guardian #2`Contact Information (if different)

Name
Address
Phone
email