Music Room Usage Agreement
Please complete this form to request and agree to the terms for using the music room.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Affiliation
*
Please Select
Student
Faculty/Staff
External Guest
Other
Date and Time of Usage
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Duration of Use (in hours)
*
Purpose of Use
*
Please Select
Personal Practice
Lesson/Instruction
Group Rehearsal
Event/Performance
Other
Number of Participants
*
List any equipment you will need (e.g., piano, drums, microphones)
Emergency Contact Name and Phone Number
*
Special Requests or Notes (optional)
Signature (Please sign below to confirm your agreement)
*
Submit Agreement
Submit Agreement
Should be Empty: