BETWEEN: _____________________________________________

School

OF THE FIRST PART,

- and -

________________________________

Parent/Guardian

________________________________

Parent/Guardian

OF THE SECOND PART

THE PARTIES HERETO AGREE as follows:

1. In consideration of the supply by the School Division of a musical instrument to the child of the undersigned,

namely _________________ , receipt of which ______________ __________________, case included 

                                                                                instrument type        serial number

_____ ______ is hereby acknowledged, the undersigned agrees to pay rental charges of $_______________

    yes    no

in respect of the said child for the period from _________________ to ________________.

2. Further, the undersigned agrees that payment of the full instrument rental charge in respect of the child will be

paid by _____________________________.

                                        date

3. It is agreed that failure to make payment as provided shall result in the School Division recovering any musical

instrument from the said child and shall render the undersigned solely responsible for providing the child with

adequate instruction.

4. The rentor is liable for replacement costs of lost equipment and for repair costs of damaged equipment.

DATED at ________________________, in the Province of Manitoba, this _______ day of _________, 19 ___.

____________________________________________                 _____________________________________

School Div. Authorized Signature                                                   Parent/Guardian (Rentor of Instrument)

                                                                                                         _____________________________________