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Albright College Instrument Rental Form

Please note that ALL fields below are required unless noted otherwise.

Student Name: First   Last

Campus Address:

Campus Phone:

Campus Email Address:

Ensemble/Private Lesson Instructor:

Instrument: Make:

Model: Serial Number:

Case? Yes No

Accessories (i.e. mouthpiece): Other:

Locker Number:

Rental Semester:

Date of Rental:

Condition of Instrument (to be completed by ensemble director/private instructor):

By checking this box, I agree to the following terms:

  1. I hereby request use of the instrument and accessories described above.
  2. I agree to be responsible for any damage or loss that may occur while in my care, and shall pay the cost of repair or replacement upon return inspection by my ensemble director/private lesson instructor. 
  3. I agree to pay for a replacement instrument if the rental is not returned by the last day of the regular semester.

* Please enter the red character in the image below: