Date *

MM

DD

YYYY

STUDENT NAME

First Name

Last Name

BRASS

Playing Condition

Remove Stuck Slides

Repair & Align Hand Slide

Ultrasonic Clean

Larger Dents

Overhaul

Repair Valves & Casings

Solder Broken Part(s)

Other (please specify):

WOODWIND

Playing Coniditon

Clean and Polish

CORK: Tenon

CORK: Head Joint

CORK: Neck

CORK: Key

Regulations & Adjustments

Solder Broken Part(s)

Replace Worn or Missing Pads

Replace Missing Screw

Replace Broken Spring

Larger Reachable Dents

Other (please specify):

CASE

Replace Latch(es)

Replace Handle

Replace Hinge(s)

Replace Entire Case

Other (please specify):

PAYMENT

Student Pays

FISD Pays