DORA BAND

Instrument Inventory Accountability Form

 

As a Dora High School Band member it is my responsibility to protect my instrument from any damages.  I agree that my instrument will be in excellent condition at all times.  This includes any props, flags or equipment for auxiliary.

 

___I will return my instrument/equipment in its entirety, in the same condition that it was issued on the assigned date.

 

_____ If my instrument is not returned in proper working condition, I understand that I may be charged for repairs and maybe the cost of the instrument.  If I fail to turn in my instrument at the proper time, the cost of instrument will be applied to my student account and my grades will be held. 

 

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Instrument Type ____________________________________  Serial

#______________________Case#________________________________

 

Check-out date_____/_______/_______                                                                                Check-in date_______/______/_______

 

Accessories included with the instrument check-out:

__ mouthpiece                                                            __neck/seat strap                                                       __tuning rod

__ finger ring                                                              __neck

__ bocal                                                                      __bits—qty_____

__m/p adaptor                                                            __swab/shove-it

 

• I understand, that by signing this document, I agree to assume responsibility for the instrument named above and for the items issued with it. Any damage that occurs beyond the scope of the notation(s) above is my responsibility except for normal wear (ie.  worn finish, brittle pads). If this instrument is lost or stolen I will report it to the Dora Band Office immediately and I will assume the responsibility of replacing the equipment.

 

 

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Print Name

 

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Signature                                                                                                   Date