Instrument Repair Permission Slip
Fill out this form if you would like Mr. Kalas to arrange to have your child’s instrument repaired by LUSCOMBE MUSIC. Instruments must be given to Mr. Kalas on Tuesday morning before 9AM. You will be billed at the address you provide below.
Student’s Name (please print) ____________________________
____________________________________
Name
____________________________________
Street
____________________________________
City, State, Zip
____________________________________
Telephone number
______If you are already renting from Luscombe you may be paying a maintenance fee which would cover the cost of repairs. Check here if you think that is true.
______Check here if you would like to be called with an estimate.
____________________________________
Signature
Below will be completed by Mr. Kalas
Instrument___________________________
Problem_____________________________