Parent Name *

First Name

Last Name

Student Name *

First Name

Last Name

Phone

(###)

###

####

Loaner Required *

We will do our best to accommodate!

Yes

No

Parent/Guardian Name *

First Name

Last Name

Phone (Best # to Reach You) *

Best # to Reach You

(###)

###

####

Work Phone

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Instrument Choice (Rental Price Shown) *

Percussion Kit: $15-23 MTM/$25 RTO - 24 months (includes rolling case, practice pad, drumsticks, bell mallets, sturdy stand, and music rack. Two kit styles to choose from. Our team will discuss styles with you upon reservation.)

Clarinet: $23 MTM/$33 RTO - 36 months: (includes case, mouthpiece, mouthpiece cap, ligature, reed, swab, cork grease)

Flute: $23 MTM/ $28 RTO - 36 months: (includes case and cleaning rod)

Trombone: $23 MTM / $40 RTO - 36 months: (includes case, mouthpiece, and slide lubricant)

Trumpet: $23 MTM / $40 RTO - 36 months: (includes case, mouthpiece, and valve oil)

Alto Sax: $40 MTM / $60 RTO - 36 months: (includes case, mouthpiece, mouthpiece cap, ligature, neck strap, reed, swab, and cork grease)

Oboe: $40 MTM / $103 RTO - 36 months: (includes case, reed, swab, and cork grease)

Baritone (Euphonium): $48/month: includes case, mouthpiece, and valve oil.

French Horn: $48/month: includes case, mouthpiece, and rotary valve oil.

Tenor Sax: $48 MTM / $71 RTO - 36 months: (includes case, mouthpiece, mouthpiece cap, neck strap, reed, cork grease, and swab)

Violin: $23/ MTM / $35 RTO - 20 months: (includes case, quality bow, and rosin)

Viola: $23 MTM / $40 RTO: (includes case, quality bow, and rosin)

Cello $36 MTM / $57 RTO: (includes padded bag, quality bow, rosin, and endpin rest)

Upright (Double) Bass $68/month: (includes padded bag, quality bow, rosin, and endpin rest)

Method Book Needed?

Yes

No

Music Stand Needed?

Yes

No

Student Name (First, Last) *

First Name

Last Name

When is instrument needed by?

MM

DD

YYYY

Parent Name *

First Name

Last Name

Student Name *

First Name

Last Name

Phone

(###)

###

####

Teacher

First Name

Last Name

Pick Up Location *

School

Home

I will drop off at Knapton

Other

Date Finished with Rental

MM

DD

YYYY