Responsible Adult

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

First Name Last Name
E-mail *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
how long
cell number *

Area Code Phone Number
Home number

Area Code Phone Number
Work number *

Area Code Phone 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 fees I 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