Harmony for All: Instrument Loan Application

Harmony for All supports individuals experiencing barriers to participation. Prior to submitting this online application form for an instrument loan, please confirm that you are either an approved Recreation Credit client, or have received a written referral from a music teacher, school administrator, youth centre worker or service agency.

This program is for City of Burnaby residents only.

Applicant information

First name

Last name

Date of birth

Phone number

Email address

Home address

Please note: 2 pieces of proof of your Burnaby address are required to be shown when we process your application (Government ID showing your Burnaby address and a bill/bank statement in the same name showing your Burnaby address).

Parent's name (if applicant is under 19)

Please indicate which of the following applies to your request for an instrument loan:

I am an approved City of Burnaby Recreation Credit client

I am providing a written professional reference

Professional reference information

First name

Last name

Organization name

Phone number

Relationship to the applicant

Please upload your written referral

One file only.
15 MB limit.
Allowed types: pdf, doc, docx.

Your privacy

Your personal information is being collected and used for the purpose of administering the Harmony for All instrument lending program and will be managed in accordance with s. 26 (c) of the Freedom of Information and Protection of Privacy Act. For questions regarding the collection of your personal information and receipt of electronic messages, please contact Marketing and Corporate Communications at [email protected].

Harmony for All: Instrument Loan Application

Applicant information

Professional reference information

Instrument loan request