Student Name *

First Name

Last Name

When is instrument needed by?

MM

DD

YYYY

Parent / Guardian Name *

Individual responsible for rental

First Name

Last Name

Phone *

Best # to Reach You

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Instrument Choice *

Necessary accessories included!

Percussion Kit

Clarinet

Flute

Piccolo

Trombone

Trumpet

Alto Saxophone

Oboe

Euphonium

French Horn

Tenor Saxophone

Viola

Cello

Upright Bass

Additional Accessories

These are not included in the rental price. They will be delivered to the school along with instrument unless other arrangements are made.

Method Book

Music Stand

Shoulder Rest (if playing violin or viola)

Additional Reeds