2015‐2016 Student / Parent iPad Agreement and Accidental Damage Protection Form (To be completed by parents and students new to the district only – if signed and returned previously, then a new one is not needed) *PLEASE PRINT CLEARLY* Student Name: _______________________________________ Grade: ______ Parent Name: ________________________________________ Home Address: ___________________________________________________________ Home Town: ________________________________ Home Zip: ___________________ Students are issued an Apple iPad for their educational use. It is our belief that if reasonable precautions and care are taken in the use of the iPad, it should not experience physical damage. Each student and parent is asked to read this form carefully. The parent and the student should initial next to each statement that follows, and sign at the appropriate location on page 2 of this document. Personal Responsibilities 1. Student Initials Parent Initials 2. 3. 4. 5. 6. 7. 8. Acknowledgement I understand that the iPad and its accessory equipment are the property of South Montgomery Schools. I understand that the student, with the support of the parent, is responsible for the daily care and maintenance of the iPad. I understand and agree to abide by the rules and regulations of the SMCSC Technology Responsible Use Policy as outlined in the student handbook. Failure to abide by this policy will result in disciplinary action. I understand that the iPad will be returned at the corporation’s discretion for upgrades and maintenance. I understand that I must report all iPad damages or the theft/loss of the iPad to the building designee immediately. I understand that the iPad should be transported in a suitable protective bag as a reasonable precaution against damage, theft, or loss. I understand that I will be responsible for all repair/replacement charges associated with iPad damages caused intentionally, through a lack of reasonable precautions, or loss/theft. Cost will be set by repair professionals authorized to act in such capacity as part of the agreement between the school and manufacturer. I understand that, unless instructed otherwise by a teacher, all students must have their fully charged iPad with them each day. FLIP FOR SIDE 2 Accidental Damage Protection 1. Student Initials Parent Initials 2. 3. 4. 5. 6. Acknowledgement I understand that each iPad requires accidental damage protection coverage. I am responsible for the annual $15 coverage fee. This protects me from financial liability for accidental damage for the first instance. Any instance of accidental damage beyond the first incident will be the financial responsibility of the parent and student. I understand that in order to receive accidental damage coverage, damages must result from an accident. Details of the accident must be submitted with every accidental damage claim form. I understand that if, in the opinion of the building administration, it is felt that the student did not exercise proper care and/or take appropriate precautions, and this behavior resulted in damage to the iPad, the cost of the repair will be the responsibility of the student/parent. I understand that in the event there are repeated ‘accidents’ of a similar nature, the school administration may view this as a situation whereby the student did not exercise proper care and/or reasonable precautions. In the event this should be the case, the cost of the repair will become the responsibility of the student/parent. I understand that in the event the iPad is stolen, I must contact the school administration immediately. I understand that a police report must also be filed. I also understand that in the event that the iPad was stolen or lost, regardless of the circumstances, I will be responsible for the full replacement cost of the iPad, just as is the case for textbooks and other school property. A signature below signifies that the student and parent has read and acknowledges the above. Student Signature: _____________________________________ Date: ___________ Parent Signature: ______________________________________ Date: ___________ This form should be completed and mailed/brought to: South Montgomery Community Schools Technology Department PO Box 8 New Market, IN 47965 OR Your child’s individual building of enrollment.
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