GUITAR

 INSTRUMENT  LIABILITY  FORM  

 
 
Name:  ______________________  
 
Date:  _______________________  
 
Item  #:  _____________________  
 
Serial  #:  ____________________  
 
Value:  $166         Condition:  __________________________  
 
I   hereby   agree   to   hold   myself   financially   responsible   for   any   damages,   except   for   normal   wear  
and  tear,  which  may  come  to  the  instrument  while  under  my  care.  
 
Student  Signature:  _________________________  
 
Parent  Signature:  __________________________  
 
 
PLEASE  RETURN  THIS  FORM  TO  MR.  SHERVEY  BY  FRIDAY,  JANUARY  25TH.    THIS  IS  WORTH  
10%  OF  THE  GRADE  FOR  THE  SEMESTER.  
 
 
(teacher  use  only)    
 
Instrument  described  above  returned  on  _______________  (date)  in  the  following  condition:  
 
EXCELLENT     GOOD     FAIR     POOR  
 
Notes:  _______________________________________________________________