iPad Usage Fee Form

iPad Usage Fee Form

For Students Grades 5 - 12
Parent Name *

First Name Last Name
How many students will be listed on this form?
Child 1

First Name Last Name
Child 2

First Name Last Name
Child 3

First Name Last Name
Child 4

First Name Last Name
Child 5

First Name Last Name
Child 6

First Name Last Name
Child 7

First Name Last Name
Child 8

First Name Last Name
Child 9

First Name Last Name
Parent: I have read and understand the iPad usage agreement.

Yes No
Student(s): I have read and understand the iPad usage agreement.

Yes No
Parent: I have discussed with my student(s) the iPad usage agreement.

Yes No
I understand the iPad Technology Fee section and what I will be responsible for.

Agree Disagree
I have discussed the iPad Technology Fee section with my student(s) and what they are responsible for.

Agree Disagree
The iPad technology fee for the 2022 - 2023 school year is:
- $30.00 for an individual student.
- $50.00 for a family.
- $15.00 for an individual student (Completed Application for Educational Benefits).
- $25.00 for a family (Completed Application for Educational Benefits).
Note: Any parent who completes the Application for Educational Benefits, whether they qualifiy or not, will be charged the reduced iPad fee rate.
I agree to pay the applicible iPad Technology Fee. *

$30 Individual $50 Family $15 Individual with Completed Educational Benefits Form $25 Individual with Completed Educational Benefits Form I decline to pay the iPad Technology Fee
Should be Empty: