CSDNR Device Loaner Form
Email address *
Did you receive a chromebook from the District during the 2019-2020 School Year? *
Student Name *
Please type your first and last name.
Student Email *
This is your child's nredlearn.org account. (Ex. jeterde29@nredlearn.org)
Parent/Guardian Name *
Parent/Guardian Email *
Parent/Guardian Phone *
School *
Student grade Level *
I agree to the following terms on the Device Loaner Form. PLEASE INITIAL AFTER READING THIS FORM. *
Captionless Image
PLEASE INITIAL BELOW IF YOU AGREE WITH THE FOLLOWING STATEMENT. The student is completely responsible for the device and its accessories while it is checked out and will not be permitted to loan the device or accessories to anyone else. *
PLEASE INITIAL BELOW IF YOU AGREE WITH THE FOLLOWING STATEMENT. If the Chromebook is damaged, it must be brought to the building office for repair as soon as possible. The parent/guardian is responsible for all costs associated with repair or replacement. *
PLEASE INITIAL BELOW IF YOU AGREE WITH THE FOLLOWING STATEMENT. The student agrees to return the Chromebook, and all accessories in the same condition in which it was checked out. Failure to return the device may result in the device being reported to the local authorities as being stolen. *
PLEASE INITIAL BELOW IF YOU AGREE WITH THE FOLLOWING STATEMENT. The student and parent have read and understand the Acceptable Use Policy in the Code of Conduct and will abide by its content. *
PLEASE INITIAL BELOW IF YOU AGREE WITH THE FOLLOWING STATEMENT. The student and the parent understand that inappropriate and irresponsible use and conduct while using the Chromebook and/or other technology resources and/or school network shall result in disciplinary action or costs associated with replacement or repair. The student agrees to be a responsible digital citizen and user, and will conduct herself/himself appropriately while online. *
By typing the PARENT/GUARDIAN NAME and STUDENT NAME below, you agree to the terms identified in this Device Loaner Form. *
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of City School District of New Rochelle. Report Abuse