Device Check-out

Device Check-out

                   

     Student Last Name        Student First Name       Device ID(Serial Number)

 

 

 

BUENA VISTA CITY PUBLIC SCHOOLS

ELECTRONIC INFORMATION NETWORKS

INDIVIDUAL USER ELECTRONIC DEVICE CHECKOUT FORM

 

Buena Vista City Public Schools

 2329 Chestnut Avenue Suite A, Buena Vista, VA 24416

540.261.2129

 

ELECTRONIC DEVICE CHECKOUT FORM 

 

Parent Name:

Parent Email Adress:

Parent Phone Number:

 

 

Device Type: Chromebook with Protective Cover and T-Mobile Hotspot if Needed

Device Value: $239.00

Protective Cover Value:  $29.95

T-Mobile Hotspot Value: $89.00

 
Chromebook Serial Number: 
 
Hot Spot Serial Number: 
 
 

This computer agreement is to signify that the above named student parent/guardian is fully responsible for maintaining this device. Prior to student checkout, this form must be signed by both the student and the student’s parent or guardian and returned to the school office.  

It is agreed that Buena Vista City Public Schools is not responsible for any loss or damage done to the device while in possession of the student.  If loss or damage occurs, the student and parent/guardian are responsible for the repair or replacement of the device.  

 
  • I have attended live or online and/or watched the recording of the Chromebook Remote Learning Orientation Video presented by Buena Vista City Public Schools and understand that my child will be receiving a Chromebook for academic use both on campus and at home.   Parent Initials:

  • I have read and agree with the Chromebook guidelines and rules and the BVCPS Acceptable Use Policy and the BVCPS Technology Use Guidelines. These documents are posted on our division website under the “Parent” portal for your full review. Parent Initials 2:

  • I consent to allow my child to accept responsibility for this device and its use for as long as it is checked out to my child or in their possession.  Parent Initials 3:

  • It is understood that unpaid bills for device misuse may result in the school putting a hold on student records.  Continued misuse of a school device may result in a loss of this privilege and potential discipline according to the guidelines in the Student Handbook.  Failure to return the device at the end of the school year will result in a police report being filed for stolen property belonging to Buena Vista City Public Schools. Parent Initials 4:

I understand and agree to these device use guidelines and authorize my student to complete the Device Checkout section on this form in order to check out the device for the school year:  

 

Parent Signature: 

Date: 

 

I have attended live or online and/or watched the recording of the Chromebook Remote Learning Orientation Video presented by Buena Vista City Public Schools and understand that I will be receiving a Chromebook for academic use both on campus and at home. I have read, agree to, and will abide by the BVCPS Acceptable Use Policy and the BVCPS Technology Use Guidelines. These documents are posted on our division website under the “Parent” portal for your full review.

 

I understand that all use of this device is my responsibility while it is checked out to me or in my possession.  

 
Student Initials: 
 

Please record all damage or major wear/use marks on the device prior to checkout. 

 

Device Checkout Condition: 

(Please list the condition of the device and any accessories - power cord, keyboard, protective cast and note any deficiencies.) 

 
ItemCondition
Chromebook
Chromebook Power Adapter
Chromebook Cover
Hotspot

 


Checkout Date: 

Student Signature: 

Staff Signature: 


 

Students are required to return the device at the end of the school year or when they withdraw from Buena Vista City Public Schools.   

 
Device Back To BVCPS
Check-in Date: 
 
Student Signature 2: 
 
Staff who checked-in device: 
 
 


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