22-23 Student Check Out Device

SY24-25 6th-8th Grade Student Technology Equipment Checkout Request Form

Section A
Student/Parent Device Agreement

In order to borrow a RAMA device, please complete this form.
Grade Level*
Homeroom Teacher*
Student Name - 6th Grade*
Student Name - 7th Grade*
Student Name - 8th Grade*
Parent Name*

First NameLast Name
Parent E-mail*
example@example.com
Phone Number*

Section B: General Handling and Required Care of the Device/Chromebook
Chromebook Number
Example: ACB000 ; We will assign the number for student.

Option 1:

Purchase insurance that will cover your device for 1 school year (SY24-25). The cost for the insurance is $45. Payment for student device coverage should be paid by September 25th, 2024. If payment is not received by September 25th, 2024 your plan will not be valid and you will be responsible for 100% of any damages incurred. Payment can be made at the following RAMA Website or Main office:

http://www.reachingallminds.com/shop

Option 2:

If you choose to decline the following charges will apply if there is any loss or damage:

Full Device Replacement	$350
Screen Broken	$200
Liquid Damage	$200
Missing Key(s) / Camera Damage	$200
Charger Replacement / Damaged	$20

*** Report any existing damage within 48 hours of receiving the device to your homeroom teacher or front office. If you are moving or transfer out and need to return your device before the end of school year, please contact your homeroom teacher or school administrator to make arrangements. If we didn't receive your device, you are responsible for full payment of the replacement. ***

The Student and Parent/Guardian will be charged for damage or loss of their issued Device/Chromebook according to the fee and fine schedule below. Final determination of applicable fee will be made by the technology department based on a student incident report and acceptance of insurance claim by insurer if applicable. (Please choose one option)*

Option 1: Purchase insurance $45 that will cover the device for 1 school year (SY24-25) -RECOMMENDED-Option 2: Decline the insurance option. This means I am responsible for any accidental or intentional damage and will be required to pay the full fee of $200 or $350 depending on the level of damage.
I have read the Technology Equipment Checkout Acknowledgment and understand that I am responsible for any such equipment assigned to my student(s). RAMA’s Acceptable Use Agreement and related Policies must be followed at all times. I hereby accept responsibility for any damage or neglect that may result from my student using the Device/Chromebook, which may result in monetary charges. I understand that the student may lose their Device/Chromebook privileges as a result of inappropriate behavior in violation of this Acknowledgment, and may be financially responsible for intentional damage, neglect, or avoidable loss to any District issued Device/Chromebook. All items must be returned at the end of the checkout term. I understand that I will be charged for any missing equipment.I have read more information here: https://docs.google.com/document/d/1TNx4ZgRhfpQtKJ4cVAaiWSizzUHKprpSeZWtoD9gGtQ/edit?usp=sharing
Signature*
Should be Empty:

Student/Parent Device Agreement