Jams Instrument Loan Form

Practice is imperative for a student to advance in musical ability; therefore, instruments are made available to take home so that students will be able to practice during lessons, as well as on their own. Each loan of an instrument is considered on an individual basis. Certain criteria must be met, such as meeting certain competency levels as set by your child's teacher, dependability, and seriousness of purpose.

Instruments are delicate and easily damaged. Utmost care is required to keep them in playable condition. Students MUST be very careful and we ask that parents/guardians NOT allow siblings to "play" with these instruments. Any and all damage will be the sole responsibility of the parents.

Student Information

Student Name *

School Name *

Grade *

JAMs Program *

Dickenson

L.F. Addington (Wise)

Big Stone Gap (SWVA Museum)

Instrument *

Student Handedness *

Left-Handed

Right-Handed

Describe student's previous experience with this or other instruments (if any):

Has student previous borrowed an instrument from WiseJAMS?

Parent/Guardian Information

Parent(s)/Guardian(s) Name(s) *

Primary Phone *

Alternate Phone 1

Alternate Phone 2

Address *

City

Zip Code

Email *

Alternate Email

Parent/Guardian Signature

By checking this box, I hereby give permission for the student named above to borrow an instrument from WiseJAMS. I understand and agree to the above conditions and will allow my child to borrow this instrument and any accessories from the WiseJAMS program. I will pay for any and all damages that occur and will replace whatever is lost while in our possession.

Parent/Guardian Agreement