Summer Device Agreement
* Required
Date
*
MM
/
DD
/
YYYY
Last Name
*
Your answer
First Name
*
Your answer
Select your builidng
*
Choose
Bacon
Culver
CFC
Holly Heights
Lakeside Middle School
Memorial
Mt. Pleasant
Rieck Avenue
Senior High
Silver Run
Thunderbolt
Other
Email Address
Your answer
Summer Telephone Number
Your answer
Select Items:
Laptop
Chromebook
IPAD
IPOD
Tablet
Other
Device Information
Make and Model number ( Example: Dell Latitude E6410)
*
Your answer
Device Name (Example: HHCJONES3LAP)
*
Your answer
Device Service Tag (Usually on the bottom of the device)
*
Your answer
Digital Signature
*
Your answer
Submit
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