Responsible Adult

Responsible Adult
This form must be filled out entirely by a responsible adult
Name*

First NameLast Name
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
how long
cell number*

Area CodePhone Number
Home number

Area CodePhone Number
Work number*

Area CodePhone Number
Place of work*
Length of time*
Previous work if less than 2 years
Driver License Number*
State of issue
Student's name and grade*
What school*
What Instrument*
Name of someone who will know how to reach you when we can't and phone*
I understand the following*

I must pay as agreed for the instrument or I will be charged additional feesI must pay as agreed for the instrument or it will be reported as stolen property which is a felony (RCW 945.062)I must return the instrument or purchase it.I must pay for repairs beyond normal wear and tear.
Signature
Should be Empty:

This form must be filled out entirely by a responsible adult