Student Name *

First Name

Last Name

Parent Name *

First Name

Last Name

Parent Phone *

(###)

###

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I am in need of the following instrument (limit one instrument per family) *

acoustic guitar

electric guitar

electric bass

violin

alto saxophone

drum set

I do not need an instrument

I need the following

(check all that apply)

new guitar strings

new bass strings

violin strings

guitar strap

guitar stand

guitar picks

alto sax reeds

1/4" instrument cable

tenor sax reeds

bari sax reeds

clarinet reeds

Other (please explain)

Do you need help installing new strings on your instrument?

Yes

No