2020 - 2021 Pro-Vision Academy Technology Device Checkout (Fill out one form for each student requesting a device)
Please read the conditions below. Provide your electronic signature by filling out the form. If you provide an email address, you will receive a copy of this form after distribution of the technology equipment is complete. We will also maintain all of the information for our records.
Parent/Student Information
Parent Last Name *
Parent First Name *
Parent's Phone Number (s)
Parent Email Address
Student Last Name *
Student First Name *
Student ID Number
Student Grade *
Pro-Vision Academy Technology Terms and Conditions
• I understand this laptop and any components issued, including chargers and hot spots, belong to The Pro-Vision Academy and that I am responsible for its physical security and condition.
• I will not leave it unattended and vulnerable to theft.
• I will not abuse the device or any components issued and understand there will be a review process upon device return.
• When I take the device off campus, I will make take measures to protect it from being stolen and will not leave it visible inside my vehicle.
• I will follow and enforce all policies and conditions of The Pro-Vision Academy’s Acceptable Use Policy (AUP).
• I understand that devices are for school use only and that I will return the device at the end of the year or upon request.
• Students are given an email account through Google. This email is for the school use only and will be monitored by the Pro-Vision Academy Technology Department.
• In the event of loss or theft, I agree to report the incident to the appropriate law enforcement agencies, whether on campus or off campus, immediately. I will notify the school within 48 hours of the incident and the case number from the appropriate law enforcement agency. I will furnish the official police report within 7 days of the initial reporting incident.
• I understand if my device at any time during the school year is deemed abused, I am responsible for the damage, $300 will be due payable to The Pro-Vision Academy. Negligent abuse includes but is not limited to, loss, missing keys, cracked screens, excessive damage to the exterior, and hardware damage due to liquid spills.
• I will not load any personal software onto this device other than what is required to connect my home Internet service provider and my home printer.
• I agree to all rules and regulations as stated in this document, the 2020 – 21 Student/Parent Handbook and the Pro-Vision Academy Board Policy.
Electronic Signature Terms and Conditions
I acknowledge that I have read and agree to the conditions as outlined in this document, the 2020-21 Student/Parent Handbook and Pro-Vision Academy Board Policy. The parties acknowledge and agree that this agreement may be executed by electronic signature, which shall be considered as an original signature. Without limitation, "electronic signature" shall include faxed versions of an original signature or electronically scanned and transmitted versions (e.g., via PDF) of and original signature.
By selecting the "I Accept" button , you are signing the Agreement electronically. You agree your electronic signature is the legal equivalent o your manual signature on this Agreement. *
Type your name and the date here: *
FOR OFFICE USE ONLY: Remaining Information will be completed when device is issued by school personnel.
FOR OFFICE USE ONLY: Items Issued: Check all that apply.
FOR OFFICE USE ONLY: Student Laptop Tag Numbers (Four digit holographic tag located inside of laptop. e.g., Tag# 1629)
FOR OFFICE USE ONLY: Student Hot Spot Tag Number (Four digit tag located on the back of the packaging. e.g., Tag# 196P)
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