Dallas County High School -Federal Programs Department Technology Take-Home Permission Form
The computer that your child is being issued is an educational tool and should be used in
that capacity. All laptops are subject to the terms of the DCSS Acceptable Use Polices
whether on or off campus. Failure to comply with the Student Computer Acceptable Use
Policy and these guidelines will result in loss of take-home privileges.

Before a student is granted permission to take their assigned technology device home, his/her
parent or guardian must sign the attached permission form.

Before the technology is assigned to a student, the parents or guardians must assume financial
responsibility for the equipment by signing the attached Technology Agreement Form. The
approximate replacement cost of the technology is $400.00.

If the technology has a failure of an internal part, it may be covered by a warranty and may be
repaired at no cost. If the technology assigned to your child is lost, stolen or damaged
through negligence, vandalism, or failure to follow the proper care guidelines, then you are
responsible for the cost of repair or replacement.

Student users MUST return the Chromebook by the date specified. A late fine will be charged at
the rate of $10.00 for each day. After 15 days the laptop will be declared lost and full
replacement cost will be due. Full replacement cost will be calculated at the cost of the laptop &
accessories of the same brand, model, and configuration when the laptop was declared lost.
Failure to return the equipment on time may result in loss of the privilege of taking the
equipment home again.

All technology is the property of the Dallas County School System. Dallas County School
System reserves the right to demand the immediate return of the equipment at any time. The
technology should only be used by the student who to whom the equipment is assigned.

If you, as the parent/guardian, would rather that the technology NOT be brought home, please
inform the school by checking the appropriate box on the permission form and we will honor
this request.

Mode of Instruction *
Student Name(s) *
School Name *
Home Address *
Phone Number *
Date Equipment Checked Out (first day of school 8/20) *
I understand that the condition of the  Chromebook is in Good/Fair condition.  I give permission for my child to sign out a technology device for use at home.I agree to the guidelines and procedures outlined on this form and agree to take full responsibility (including financial) for the chrome book.  (Sign electronically - /s/ first name last name)
Clear form
Never submit passwords through Google Forms.
This form was created inside of Dallas County Schools.