Family Mobile Device Checkout Form
With schools closed due to COVID-19, Carmel Clay Schools will provide your family with a device if you do not have one in your home.

Please understand your family is responsible for the device. If the device is damaged or lost, your family will be charged for the cost of the repair or replacement.

If you do not have a device for your home, please fill out the following form and the building staff will be in touch.
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's School ID (if known)
Your answer
Your Student's School *
Parent/Guardian Email Address *
Please provide an email address should we need to get in contact regarding device distribution.
Your answer
Parent/Guardian Phone Number
Please provide a phone number should we need to get in contact regarding device distribution.
Your answer
Additional Students and Schools
Please list any other students and the schools they attend at CCS.
Your answer
By typing my full name below, I agree that if the device is lost, stolen, or damaged I will be responsible for any charges that result. I also understand that the device is being borrowed by my child and must be returned to the school district when requested. * *
Please type your full name
Your answer
Submit
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