Avon Grove Charter School 1:1 Parent Acknowledgement/Permission Form
Please answer all questions below and click submit when complete. One submission is required per student if you have multiple students in grades 5-12 at Avon Grove Charter School.
Email address *
Demographic Information
Verify Parent/Guardian Email Address *
Your answer
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Child/Student First Name *
Your answer
Child/Student Last Name *
Your answer
Student/Lunch ID Number *
Student ID numbers are required to complete this form. You can obtain you child's School/Lunch ID number via your Parent Portal account, student's School ID, or a student's most recent report card.
Your answer
Child/Student 2019-2020 Grade Level *
Read carefully: Please choose your child's 2019-2020 grade level from the list below.
National School Lunch Program Status (Free/Reduced Lunch) *
My child has access to the internet (WiFi) at home. *
Note: We are seeking information related to student internet access at home to help connect families with resources to close the digital divide. Please answer this question based on a students access to the internet by means other than utilizing a smart phone/data plan.
Parental Acknowledgements
We (Parent/Guardian & Student) have reviewed the informational slides (http://bit.ly/2wmQbpm) of the 1:1 Chromebook overview session. *
We (Parent/Guardian & Student) have carefully read and agree to all of the provisions the AGCS 1:1 Device Program Handbook (http://bit.ly/2x7gAVQ) and understand AGCS' expectations for Chromebook responsibility, care, and use. *
We (Parent/Guardian & Student) have carefully read and agreed to the AGCS Acceptable Use Policy (https://goo.gl/q4WuV9). *
Technology Fee Information and Declarations
Parents/Guardians must declare one of the three options below.
If a family chooses Option 1, they may pay the via EduTrak, cash, check, or money order made out to Avon Grove Charter School with a note made that the payment is for the technology fee.

If your family is eligible for a "Free Lunch" via the National School Lunch program then there is no Technology Fee for your student. While there is no technology fee you would be responsible for the full cost of repairs and/or the device for damage due to negligence, loss, and/or theft.

If your family is eligible for a "Reduced Lunch" via the National School Lunch program please choose between Options 1-3 as there is a reduced technology fee for your family.

A breakdown of the 2019-2020 Technology Fee Structure can be found in the AGCS 1:1 Device Handbook.

If the school does not receive a completed declaration (either via paper or digitally) by the first day of school, the school will choose to enroll the student in the yearly technology fee option as described under Option 1. A financial obligation will be issued and added to a student's school account until the fee is paid.

New students enrolling with AGCS will receive the same or newer make/model/year computer as their grade level classmates. New students enrolling with AGCS throughout the year are expected the pay the full technology fee upon enrollment.
Technology Fee Declaration *
Electronic Signatures
By electronically signing this agreement, Student/Parent/Guardian agrees to the 1:1 Device Handbook Policies and Procedures, AGCS Acceptable Use Policy, and agrees to:

- To abide by all policies, procedures, rules, and expectations within the 1:1 Handbook.
- To abide by all Avon Grove Charter School’s Acceptable Use Policy guidelines
- To use the equipment for educational purposes only.
- That Internet access will be filtered and monitored at all times
- To not install, remove, or make any alterations to the equipments hardware, software, or operating system
- To report any problems or damages immediately to the school
- That the equipment is the property of Avon Grove Charter School
- To return the equipment when asked or transferring out of the school
- That any damage due to loss or negligence or lack of reasonable care will be the financial responsibility of the
- That all yearly technology fees are paid in full prior to being issued the device
- That all equipment, software, and internet use will be done so with good faith

By signing this form, the Student and the signing Parent/Guardian acknowledge and agree that the school reserves the right, at all times and without prior notice, to access, inspect, and search any and all its property for the purpose of determining whether any policy has been violated, or when an inspection and investigation is necessary for purposes of promoting safety or compliance with state and federal laws.
Parent/Guardian Signature: Please type you first and last name in the field below. This serves as your electronic signature. *
Your answer
Relationship to Student *
My family interested in sponsoring a child who cannot afford the annual technology fee.
A copy of your responses will be emailed to the address you provided.
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