Mother Lode Chromebook Check-Out Request
Chromebooks can be picked up on Tuesday April 14, between 11 am and 1 pm. By signing for a chromebook, you are agreeing to return it to the District upon the re-opening of school.
Student First Name
Student Last Name
Parent/Guardian Phone Number - (include best time of day to call)
Parent/Guardian Accepts Responsibility For Device and Appropriate Use
I Accept Responsibility
I DO NOT Accept Responsibility
Due to hardship, I need a Chromebook but cannot pick-up.
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This form was created inside of Mother Lode Union School District.