e-Learning Day Device Request
If your child needs to sign-out a device with internet access to complete their e-Learning Day assignments,
Please fill of the form below and we will contact you to make arrangements for pick-up.

*DUE TO HIGH DEMAND - PLEASE ONLY REQUEST A DEVICE IF YOU DO NOT CURRENTLY HAVE ACCESS TO A DEVICE WITH INTERNET ACCESS AT HOME - THANK YOU
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Date: *
MM
/
DD
/
YYYY
Parent/Guardian Last Name: *
Parent/Guardian First Name: *
Student Last Name: *
Student First Name: *
Phone Number: *
Email Address:
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