String Instrument Bank Loan Request Form printable pdf download

WESTERN UNIVERSITY Don Wright Faculty of Music

STRING INSTRUMENT BANK LOAN REQUEST FORM - FALL/WINTER 2016/2017

Please EMAIL signed request form to: avogel@uwo.ca

Student Name:

Student Number:

Home (Parents) Address:

Home (Parents) Phone#

Home (Parents) E-Mail:

London Address:

London Phone Number:

Street:

E-Mail:

Postal Code:

Are you requesting an instrument, bow, or both?

If you have a specific instrument and/or bow in mind, please list it/them:

Teacher’s Signature:

Date:

CONDITIONS OF LOAN

1. The borrower has received the listed equipment in good condition. The borrower accepts full responsibility for any loss or damage to it, as

outlined in the University Policy and Procedures relating to off-campus use of equipment.

2. The borrower agrees to pay a non-refundable user fee of $100.00 to borrow a bow and $100.00 to borrow an instrument per academic year

or any portion thereof. UWO is responsible for repair costs beyond the above amount, except where damage or loss results from the

borrower’s negligence.

3. The borrower is responsible for the purchase of any new strings for the instrument.

4. Any student wishing to be considered for a loan from the String Instrument Bank has to attend the Annual String Maintenance Workshop

in September.

5. The borrower may not take the instrument/bow in for repair. All repairs are at the sole discretion of the Don Wright Faculty of Music.

Requests for adjustment or repair must be made to the String Bank Director for consideration.

6. String Bank instruments/bows may not be transported by air. In all cases where extensive or long-distance travel is involved, prior

approval for transportation of a String Bank instrument/bow must be received from the String Bank Director /Dean of Faculty of Music.

7. The borrower agrees to use the instrument/bow only in Ontario unless prior permission to use it outside Ontario is obtained from the

String Bank Director.

8. The borrower will return the borrowed instrument/bow to Len Ingrao during his posted office hours no later than Thursday, April 13,

2017 Borrower’s initials here:______________. Borrowers who fail to meet this deadline without requesting / receiving prior written

permission from the String Bank Director to return it at a later time are subject to a fine of $100.00 per overdue week or any portion thereof.

All UWO records pertaining to the delinquent borrower will be sealed until the instrument / bow is returned and the borrower’s fine is paid.

9. The borrower will return the instrument/bow within 24 hours if demanded by UWO. Borrowers who fail to return the instrument/bow are

subject to a fine of $100.00 per overdue week of any portion thereof. All UWO records pertaining to the delinquent borrower will be sealed

until the instrument/bow is returned and the borrower’s fine is paid.

10. The borrower agrees to publicly acknowledge the use of the above instrument/bow on ANY printed program with a short

statement such as:

“Special thanks to the University of Western Ontario Don Wright Faculty of Music String Bank for the generous

loan of the instrument/bow used in this performance.”

FOR INFORMATION

Students wishing to borrow instruments/bows for the summer must re-apply to borrow the instrument/bow for the summer, at which time a

separate String Bank Instrument Loan Request form must be completed. The prospective summer borrower must first return his/her

borrowed item in April to Mr. Ingrao according to the guidelines in #6. Following an inspection of the instrument/bow by an outside

consultant, and if the terms of his/her proposed summer use of the instrument/bow are acceptable to the String Bank Director, the student

may borrow the instrument/bow for the summer. The borrower must return the instrument/bow by the date agreed on in the summer rental

agreement. If the borrower wishes to borrow an instrument/bow the following school year, he/she must re-apply. The summer borrower

must pay a separate $100.00 user fee for summer use of an instrument, and a separate $100.00 user fee for summer use of a bow.

I have read and agree to all above “Conditions of Loan”

Signature of Borrower:

Date:

Signature of String Bank Director:

Date:

String Instrument Bank Loan Request Form

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