Lewisburg Area School District Technology Protection Plan/Waiver Form

Lewisburg Area School District Technology Protection Plan/Waiver Form
The purpose of this form is to ensure that parents and guardians understand the LASD Technology Protection Plan (TPP) and to provide the opportunity to either enroll in or waive the plan for their child’s school-issued device.
- For middle school students, the TPP applies to Chromebooks.
- For high school students, it applies to MacBooks.
At Lewisburg Area School District, we provide free repairs for devices, cases, and chargers that experience normal wear and tear, regardless of whether a student is enrolled in the plan.

However, the TPP also covers accidental damage and theft. If you choose not to enroll in the TPP, you will be responsible for any repair or replacement costs resulting from accidental damage, loss, or theft.

Plan pricing varies based on the type of device and the student’s lunch status. If you choose to purchase the plan, please select the appropriate device and lunch status to determine the correct price. Lunch status will be verified.

By signing this form, parents/guardians acknowledge their understanding of the Technology Protection Plan and confirm their decision to either purchase or waive coverage.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email Address
example@example.com

Student Name(s) (Grades 6-12 only)

	First Name	Last Name	Grade for Upcoming Year
Student 1
Student 2
Student 3
Student 4

Device Protection Plan Decision*

I choose to purchase the protection plan.I choose to waive the protection plan, accepting full financial responsibility for any damage or loss of the device.

Device Protection Plan*

Chromebook Protection Plan (Middle School)

$25.00 QuantityLunch Status
Item subtotal:$0.00

MacBook Protection Plan (High School)

$50.00 QuantityLunch Status

Total

$0.00

Payment Information
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Signature*

Clear
Should be Empty: