Daybreak Chromebook Check Out Request Form - March 2020
Parents & Guardians,

In order to facilitate and support at-home learning over the next few weeks, Daybreak Elementary is prepared to check out Chromebooks to families in need of devices. If your student is in need of a device to use at home to access the curriculum and information teachers will be sending, please fill out this form.

If you have more than one student that needs a device, you will need to fill out this form for EACH of your students. Ex: 2 student devices = 2 forms, 3 student devices = 3 forms, etc. We do have limited devices.
Email address *
Email Address *
Students first and last name *
Grade *
Teacher Name *
The Chromebook issued is the property of Jordan School District. Student use of the Chromebook is dependent on the following:General Procedures and Guidelines (Do’s and Don’ts of Chromebook use)
Students will follow Jordan School District Policy AA445 Student Information Network Acceptable Use Policy (Student Information Network Acceptable Use Policy-AA445).
Students must bring their Chromebook back to the school. If the Chromebook is not returned, the student and parents/guardians will be responsible for the replacement cost.
Chromebook is for academic purposes only. Students will use their Chromebook to complete academic tasks and further their education.
Students must keep passwords and usernames secure and never share passwords with other students or individuals.
Keep the Chromebook away from extreme temperatures.
Always close the lid before transporting the Chromebook, and do not carry it by the screen. The screen and keyboard are susceptible to damage through misuse.
Students will not modify user settings on their Chromebook.
Students are not permitted to download any content onto their Chromebook, other than class assignments, without permission from the school.
Students will not use the Chromebook webcam to photograph any other student, teacher, or person unless for academic purposes, and only with the other person’s consent.
Students will not use the Chromebook microphone to record any other student, teacher, or person unless for academic purposes, and only with the other person’s consent.
Students will not stream any music (Pandora, Spotify, Youtube, etc.) or play any games on the Chromebook.
Sound should be muted while using Chromebook during live lessons unless given alternative direction from the teacher.
Students should not have food or drinks (including gum) near the Chromebook.
Students must use only the Chromebook assigned to them and should never leave their Chromebook unattended or allow others to use their Chromebook.
Students should not not remove any district and school identifying labels.

Beginning and School Closure Procedures
At the beginning of school closure, students will be assigned a Chromebook.
Students and parents will need to sign indicating they have read Chromebook agreement and are liable for any damages.
If a student withdraws during the school closure, they will return the Chromebook to school or be fined for the cost of the Chromebook.
At the end of school closure, students will return the Chromebook for servicing, and fines will be assessed for any damage to the Chromebook.

Expectations of Privacy
Chromebooks are the property of JSD, and are not subject to the same privacy expectations as private property. For this reason, there is no expectation of privacy with the Chromebooks.
JSD may repossess and search the Chromebook at any time. This includes any violation of school or district policies (Student Information Network Acceptable Use Policy-AA445).
All internet activity on the Chromebook, at or away from school, will be filtered by Jordan School District content filters.

Taking Care of the Chromebook
Students and parents accept responsibility for safeguarding the Chromebook.
Students should never attempt to repair the Chromebook.
If the Chromebook becomes damaged or broken due to negligence, the student and parents will be held liable for the repair or replacement of the Chromebook.
If the student loses the Chromebook, or it is stolen, they are responsible for the replacement fee. For stolen Chromebooks, a police report must be filed.
Repair and Replacement costs are as follows:
Lost device - $250.00
Stolen device with police report - $150.00
Stolen device without police report - $250.00
Power cords and chargers - $20.00.
Damage (intentional or accidental) = Cost of replacing damaged item
I agree with the guidelines and expectations outlined in this Agreement and I understand that violation of the Chromebook Use Agreement and/or Jordan School District Policy AA445 Student Information Network Acceptable Use Policy will result in disciplinary action, the revoking of Chromebook and network privileges, and the replacement of the damaged device (if applicable). * * *
Parent/Guardian First & Last Name * *
Parent/Guardian Contact Phone Number * *
Never submit passwords through Google Forms.
This form was created inside of Report Abuse