Course                                          

Teacher                                          

JOHN TAYLOR GRAPHING CALCULATOR LEASING FORM

I, (print)__________________________________ (parent/guardian) of the John Taylor student

(print)________________________________, agree to have my son/daughter lease the TI-83

graphing calculator for the duration of the semester ________ of the school year_______.

I will pay the $30.00 semester fee (circle one):

______________ In one payment of $30.00. Circle one of: by CHEQUE   or    CASH

If the calculator is NOT returned at the end of the semester, I agree to pay the remaining cost of $100.00 to replace the calculator.  The total cost of the replacement is $130.00.

Student Signature ___________________________________________

Parent/Guardian Signature ____________________________________

Teacher Signature ___________________________________________

Serial Number                                                                                                        

Bar Code Number                                                                                                  

Issued Date                                                                                                            

Date Returned   (day of final exam)                                                           

Deposited