2020-21 5th Grade Pioneer Chromebook Policy, Insurance, and Social Media Signature Page
This form serves as the signature page and acceptance for the ISD 484 Chromebook Policy, Insurance Options, and Social Media and Internet Use Agreement for 5th grade. Please review the movie with your student and have them sign the Respectable/Acceptable Use Section by typing their name.
Last Name of Student
First Name of Student
Chromebook Usage Policy Acceptance
By typing your parent/guardian name, this acts as your signature, accepting and agreeing to the 2020-21 Chromebook Policy and Social Media responsibility awareness and agreement. These documents can be reviewed on the "Chromebooks at Pioneer" page under the Elementary tab from the district web page.
Typed signature of Parent/Guardian
Chromebook home with student?
I WILL NOT allow my student to take his/her Chromebook home
I WILL allow my student to take his/her Chromebook home
Decline or Accept the Optional Insurance - Choose only one
Choose one option and sign by typing in your name as the parent/guardian. By typing your name you also accept that losing the Chromebook charger will result $30 replacement cost paid by you, the parent/guardian. This is not covered by insurance.
I AM WAIVING THE OPTIONAL INSURANCE: I have read and agree to the terms and conditions of the 2020-21 1:1 Chromebook Policy, and I will NOT be purchasing the insurance. I understand by waiving the $25 insurance fee, I will be solely responsible for any Chromebook repairs as outlined in the Chromebook Policy document. I will also be responsible for full replacement of the device in the case of loss or theft of the Chromebook.
I WILL PURCHASE THE OPTIONAL $79 INSURANCE WHICH WILL COVER CHROMEBOOK UNTIL THE END OF 8TH GRADE YEAR: I have read and agree to the terms and conditions of the 2019-20 1:1 Chromebook Policy and WILL be purchasing the $59 non-refundable insurance. I understand this insurance will pay for cost of repairs through my child's 8th grade year, provided the issued protective cover is attached to the Chromebook at all times as outlined in the Chromebook Usage Policy. I also understand that negligent use, vandalism, and/or loss of the Chromebook (not including theft) is not covered under the insurance fee.
Typed Signature of Parent/Guardian
Respectable & Acceptable Chromebook Use - Student Signature
Respectable & Acceptable Use of Chromebooks -
-Use digital devices, networks and software in school for educational purposes and activities.
-Bring Chromebooks to school each day charged and ready for use.
-Leave protective case/shell on Chromebook at all times.
-Keep Chromebook in the carrying bag provided by ISD 484 when transporting the device to and from school.
-Keep my personal information (including home/mobile phone number, mailing address, and user password) and that of others private.
-Show respect for myself and others when using technology.
-Refrain from using Chromebook for personal entertainment, including social media and YouTube unless instructed by your teacher.
-Charge Chromebook at night so it is ready for school the following day.
-Give acknowledgement to others for their ideas and work.
-Report inappropriate use of technology immediately.
Caring for your Chromebook:
I agree to the Respectable and Acceptable Chromebook Policies and have viewed the Chromebook Care video - STUDENT: type your name as a signature and accepting that you will be nice to your Chromebook!
Send me a copy of my responses.
Never submit passwords through Google Forms.
This form was created inside of Independent School District 484.