Laptop Take-Home Agreement
2020-2021 School Year

This document is for parent/guardian use only. Students are not to fill this form out. Falsifying any information, acknowledgement and/or permission on this form could breach district policies and could result in disciplinary actions.
*Please fill out a separate form for each of your children.
Email address *
Student First Name *
Student Last Name *
Parent or Guardian Name *
Which school does your child attend? *
What grade is your child in?
Clear selection
We have enough internet connection at home to support remote learning. *
This is not an insurance plan.
This plan is intended to reduce the cost burden to families for devices that are accidentally damaged, lost, or stolen. Full costs may be billed if the district administration determines that the damage is intentional or caused by extreme negligence. This plan is not transferable if the student leaves MSAD58. A pro-rated refund will be available upon request within 30 days of a student transfer.
Would you like to participate in our laptop protection plan? *
Please make checks payable to MSAD 58, NOT the Local School. If you would like to participate in the protection plan: *
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