Date *

MM

DD

YYYY

STUDENT NAME *

First Name

Last Name

BRASS

NOTE: "Playing Condition" includes service to valves & slides; up to 2 solder points; new corks & felts as needed; removal of small accessible dents.

Playing Condition

Clean & Polish

Remove Stuck Slides

Repair & Align Handslide

Ultrasonic Clean

Larger Reachable Dents

Overhaul

Repair Valves & Casings

Solder Broken Part(s)

Other (please specify):

WOODWIND

Playing Condition

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 or Missing Spring

Larger Reachable Dents

Other (please specify):

CASE

Replace Latch(es)

Replace Handle

Replace Hinge(s)

Replace Entire Case

Other (please specify):

PAYMENT

Individual Student Pays

School District Pays

Booster Program Pays