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Lake Orion Community Schools Device Protections Coverage Registration Form
** This registration will take approximately 5 minutes to complete. You will need a phone number and your student's school ID to register. Each student will have to registered separately**
This is only for students who are enrolled in grades 6-12
Laptop Cost
$51.75
Ipad Cost
$31.75
Lake Orion Family Cap
$174.50
Number of Students to Register
*
Example: 1,2, etc. This form can only register a maximum of 7 students at once.
Date
*
.
Month
.
Day
Year
Type of device wanting coverage for?
*
Please Select
Laptop
iPad
Please enter your telephone number:
*
The phone number is 10-digits
Please enter your email:
*
Confirmation Email
Student One
Student One Purchasing Coverage for:
*
Laptop Coverage
Please enter your child's student ID:
*
Student ID is 5-digits
Student One First Name:
*
Student One Last Name:
*
School Building:
*
Please Select
Blanche Sims
Carpenter
Dragon Virtual
Early Childhood Center
LOHS
Learning Options
Oakview Middle
Orion Oaks
Paint Creek
Pine Tree
Scripps Middle
Stadium Drive
Waldon Middle
Webber
Grade of Student:
*
Please Select
DK
K
1
2
3
4
5
6
7
8
9
10
11
12
14
End Student One
Student Two
Student Two Purchasing Coverage for:
*
Laptop Coverage
Please enter student two's student ID:
*
Student ID is 5-digits
Student Two First Name:
*
Student Two Last Name:
Student Two School Building:
*
Please Select
Blanche Sims
Carpenter
Dragon Virtual
Early Childhood Center
LOHS
Learning Options
Oakview Middle
Orion Oaks
Paint Creek
Pine Tree
Scripps Middle
Stadium Drive
Waldon Middle
Webber
Student Two Grade:
*
Please Select
DK
K
1
2
3
4
5
6
7
8
9
10
11
12
14
End Student Two
Student Three
Student Three Purchasing Coverage for:
*
Laptop Coverage
Please enter student three's student ID:
*
Student ID is 5-digits
Student Three First Name:
Student Three Last Name:
Student Three School Building:
*
Please Select
Blanche Sims
Carpenter
Dragon Virtual
Early Childhood Center
LOHS
Learning Options
Oakview Middle
Orion Oaks
Paint Creek
Pine Tree
Scripps Middle
Stadium Drive
Waldon Middle
Webber
Student Three Grade:
*
Please Select
DK
K
1
2
3
4
5
6
7
8
9
10
11
12
14
End Student Three
Student Four
Student Four Purchasing Coverage for:
*
Laptop Coverage
Please enter student four's student ID:
*
Student ID is 5-digits
Student Four First Name:
Student Four Last Name:
Student Four School Building:
*
Please Select
Blanche Sims
Carpenter
Dragon Virtual
Early Childhood Center
LOHS
Learning Options
Oakview Middle
Orion Oaks
Paint Creek
Pine Tree
Scripps Middle
Stadium Drive
Waldon Middle
Webber
Student Four Grade:
*
Please Select
DK
K
1
2
3
4
5
6
7
8
9
10
11
12
14
End Student Four
Student Five
Student Five Purchasing Coverage for:
*
Laptop Coverage
Please enter student five's student ID:
*
Student ID is 5-digits
Student Five First Name:
Student Five Last Name:
Student Five School Building:
*
Please Select
Blanche Sims
Carpenter
Dragon Virtual
Early Childhood Center
LOHS
Learning Options
Oakview Middle
Orion Oaks
Paint Creek
Pine Tree
Scripps Middle
Stadium Drive
Waldon Middle
Webber
Student Five Grade:
*
Please Select
DK
K
1
2
3
4
5
6
7
8
9
10
11
12
14
End Student Five
Student Six
Student Six Purchasing Coverage for:
*
Laptop Coverage
Please enter student six's student ID:
*
Student ID is 5-digits
Student Six First Name:
Student Six Last Name:
Student Six School Building:
*
Please Select
Blanche Sims
Carpenter
Dragon Virtual
Early Childhood Center
LOHS
Learning Options
Oakview Middle
Orion Oaks
Paint Creek
Pine Tree
Scripps Middle
Stadium Drive
Waldon Middle
Webber
Student Six Grade:
*
Please Select
DK
K
1
2
3
4
5
6
7
8
9
10
11
12
14
End Student Six
Student Seven
Student Seven Purchasing Coverage for:
*
Laptop Coverage
Please enter student seven's student ID:
*
Student ID is 5-digits
Student Seven First Name:
Student Seven Last Name:
Student Seven School Building:
*
Please Select
Blanche Sims
Carpenter
Dragon Virtual
Early Childhood Center
LOHS
Learning Options
Oakview Middle
Orion Oaks
Paint Creek
Pine Tree
Scripps Middle
Stadium Drive
Waldon Middle
Webber
Student Seven Grade:
*
Please Select
DK
K
1
2
3
4
5
6
7
8
9
10
11
12
14
End Student Seven
Parent/Guardian digital signature:
*
First Name
Last Name
Sub Total
Total Cost - **if the family cap has been met the total cost will be $174.50 **
Payment Type:
*
Credit Card
Device Protection Coverage
*
prev
next
( X )
USD
Description
Credit Card Information
Family Maximum
There is a family maximum of $174.50. You will have to register each child individually first. You will receive a confirmation email for each child with details of how to complete payment.
Submit
Should be Empty: