Student Technology Loan - Parent Acknowledgment Form

The purpose of this form is to permit students to be assigned individual technology, including laptops and tablets. Where appropriate to a student’s educational needs and program (and with the approval of a supervising teacher), it is understood that students may temporarily remove the technology from the school premises from time to time. Normally this would be to bring the technology home to support the student’s learning. In order for this to happen, a student’s parents or guardian accept responsibility for the care and use of the equipment when off-premises, including the appropriate use of a device’s Internet browsing capabilities.

All use of district-owned equipment, regardless of the location in which it is used, must conform to the school and school district’s Acceptable Use terms.

Equipment Loaned

In the space below, please list the equipment that is being assigned to your child that is to be brought home from time to time. If a device has a district assigned name, please include that name in the description of that device.

Please note that equipment specific information requested below would have been sent to you directly. Contact the school administrator or Principal for this information.

Details of Equipment Loaned

Re-order	Device Description	Serial Number	Weight	Operations
	Device Description	Serial Number	Item weight

more items

Student Information

First Name

Last Name

School

Grade

Parental Acknowledgement

Parent or Guardian Full Name:

I understand that I accept responsibility for the appropriate use of the equipment listed above when it is brought home. I also understand that I am financially responsible for damage to the equipment from neglect and misuse when the equipment is outside of the school and its premises, including while it is being transported to and from school.

I am not a robot 3 + 0 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.