Learning Device Check-Out Agreement Form - CHHS
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Student LAST Name *
Student FIRST Name *
ID Number (Six Digit Lunch Number) *
Grade Level *
Please read this agreement before signing below.
I authorize the check-out of a learning device and a charger to my child for the purpose of completing digital learning assignments. I/we understand that the learning device is to be used for educational purposes only. In addition, I understand that the learning device is property of the Douglas County School System. At any time, DCSS reserves the right to request the return of the learning device. My child will comply with the DCSS Acceptable Use Regulation IFBG-R1 as found at www.DCSSGA.org. Please be aware that your student will be held responsible for returning the technology equipment in the same condition as issued. I understand that I will be financially responsible for up to $250.00 for the loss of or any damage to the learning device. In the event of lost or damaged equipment, a report must be made immediately to school personnel. If your child transfers from the Douglas County School System, the learning device and charger should be returned to the issuing school before leaving.
STUDENT Digital Signature (By retyping your full name here, you agree to the terms outlined above.) *
Parent Name *
PARENT Digital Signature (By retyping your full name here, you agree to the terms outlined above.)
Today's Date *
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Best phone # to reach parent *
PARENT email address *
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