Student Computer Check-Out/Lease Form

Student Computer Check-Out/Lease Form

Inspire School District 

Student Chromebook Distribution

Student Information

• Student Name: ________________________________

• Grade Level: _________________________________

• Student ID Number: ___________________________

• School Name: ________________________________

• Student Email Address: ________________________

Parent/Guardian Information

• Parent/Guardian Name: ___________________________

• Phone Number: ________________________________

• Email Address: _________________________________

Chromebook Information

• Chromebook Model: HP Chromebook x360 14-inch FHD IPS Touch 2-in-1

• Serial Number: _________________________________

• Asset Tag Number: _____________________________

Terms and Conditions

By signing this form, the student and parent/guardian acknowledge and agree to the following terms:

1. Ownership: The Chromebook is the property of [School District Name] and is provided to the student for educational purposes. The Chromebook is on loan and must be returned at the end of the school year or upon request.

2. Insurance: The student and parent/guardian agree to pay a $20 insurance fee, which covers the Chromebook for accidents or damages during the school year. The district is covering the remaining $90 of the insurance cost.

3. Mobile Data: The Chromebook includes built-in mobile data, providing 50GB of data per month for use outside of school. Inside the school, the Chromebook will automatically connect to the school Wi-Fi network.

4. Technology Code of Conduct: The student agrees to follow the district's Technology Code of Conduct (a copy of which is attached to this form). The code includes guidelines on responsible use, acceptable behavior, and the consequences of misuse.

5. Responsibility for Care: The student is responsible for the proper care and maintenance of the Chromebook. This includes, but is not limited to, keeping the device clean, protecting it from damage, and using it only for educational purposes.

6. Lost or Damaged Devices: The student and parent/guardian are responsible for the replacement or repair cost if the Chromebook is lost, stolen, or damaged beyond normal wear and tear. Failure to return the Chromebook in working condition at the end of the school year will result in a fee for replacement.

7. Return of Chromebook: The Chromebook must be returned at the end of the school year or when requested by the district. Failure to return the device may result in additional charges or disciplinary action.

8. Termination of Use: The district reserves the right to terminate the student's use of the Chromebook if there is a violation of the Technology Code of Conduct or any district policies.

Signatures

By signing below, the student and parent/guardian acknowledge that they have read and understood the terms and conditions for the Chromebook loan, agree to follow the Technology Code of Conduct, and accept responsibility for the care and use of the Chromebook.

Student Signature: ____________________________
Date: ________________________

Parent/Guardian Signature: ____________________
Date: ________________________

Payment of Insurance Fee:
☐ Paid via online portal
☐ Paid via check/cash (amount: $20)
☐ Other (please specify): ___________________________

For School Use Only

• Form Received By: ___________________________

• Date Received: ______________________________

• Chromebook Issued: Yes / No (circle one)

• Serial Number Recorded: Yes / No (circle one)

• Asset Tag Number Recorded: Yes / No (circle one)