New Submission

**ATTENTION PARENTS: This form must be completed for every child**
Datefield type date
Student Number*field type single line
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School*field type single line
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Grade*field type single line
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**If you do not know your child's student number, please contact your school's secretary for assistance.**
First Name*field type single line
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Middle Namefield type single line
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Last Name*field type single line
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Parent First Name*field type single line
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Parent Last Name*field type single line
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Parent Phone*field type single line
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Parent Email*field type email

Student Signature

*field type checkbox
I have read, understand, and agree to abide by the terms of the Network & Device Use Agreement (Policy3270) of the Bonneville Joint School District 93. Should I commit any violation or in any way misuse my access to the School District’s computer network and the Internet, I understand and agree that my access privilege may be revoked and school disciplinary action may be taken against me. I understand that any violation of the terms and conditions set forth in the policy and guidelines is inappropriate and may constitute a criminal offense. As a user of the school districts computers/network and the Internet, I agree to communicate over the Internet and the Network in an appropriate manner, honoring all relevant laws, restrictions and guidelines.
Student Signature*field type signature
Datefield type date

Parent Signature

*field type checkbox
I have read and understand that my child is agreeing to abide by the terms of the Network & Device Use Agreement (Policy3270) of the Bonneville Joint School District 93 and my responsibilities as the parent/guardian.
Parent Signature*field type signature
Datefield type date

Chromebook Checkout

Do you want to checkout a chromebook for this child?*field type radio button
Do you want to checkout a chromebook for this child?YesNo

One to One Chromebook Student and Parent/Guardian Responsible Use Agreement

Bonneville Joint School District 93 is supplying all students with a Chromebook device. The Chromebook will allow students access to educational applications, web-based tools and many other useful sites. The Chromebook is an educational tool not intended for gaming, or social networking, and all users will be expected to follow the Bonneville Joint School District 93’s policy 5330 Computer/Network Acceptable Use Agreement as well as all other state and federal laws, board policies and administrative procedures.
Receiving Your Chromebook
One Chromebook and power cord are being loaned to the student which is in good working order. The student and parent/guardian acknowledges and agrees that use of the District property is a privilege and that by the student and parent’s/guardian's agreement of these terms, they acknowledge their responsibility to protect and safeguard the district property and to return it in the same good condition upon request by the Bonneville Joint School District 93.
Parents/Guardians and students must sign and return this agreement before the Chromebook can be issued to the student.
Chromebooks will be collected at the end of each school year, on a date to be determined, so they can be checked for serviceability and to be stored for the summer.
There will be no cost for students unless there is damage or neglect that is not covered by the optional Voluntary Chromebook Protection Plan.
Ownership
The Chromebook is owned by the school district and will remain the property of Bonneville Joint School District 93 and is loaned to the student for educational purposes only for the academic school year.
Care and Responsibility
The student is responsible for the general care of the Chromebook that has been issued by the school.
Chromebooks that are lost or stolen must be reported immediately to the main office of the school where the student is attending. If a theft occurred at school or at a school related event or activity please report to your principal.
Identification labels have been placed on the Chromebooks. Both the serial number and name stickers on the Chromebook will be used to identify its assigned student in case of loss or theft.
These stickers must not be removed or modified. If they become damaged or missing please contact your school's administration.
Student Safety
All student 1:1 computing devices are configured to filter internet content and communications at school, at home, and on any other network.
All electronic communications, activities, and files created and/or accessed on District 93 technology are not private and are subject to being viewed, monitored, and/or archived by the district at any time.
Content Filter
The district utilizes an Internet content filter that is in compliance with the federally mandated Children’s Internet Protection Act (CIPA). All Chromebooks, regardless of physical location and internet connection, will have internet activity filtered. Despite the filter, the district cannot guarantee that all controversial or inappropriate materials will be blocked.
While internet filtering is intended to restrict access to inappropriate or non-educational content, District 93 cannot guarantee that students will not intentionally or unintentionally access content that may be deemed unacceptable. If you accidentally access inappropriate content on your device, report it to school staff immediately.
Chromebook Damages, Repairs and Warranties
All Chromebook problems must be reported to the office. If you opted into the Voluntary Chromebook Protection Plan the district will repair or replace the damaged equipment resulting from normal use. If you did not opt into the Voluntary Chromebook Protection Plan you will need to pay for the cost of repairs or a replacement if the damage is too significant to repair. The district will make its best attempt to purchase replacement parts at the best possible price.
All required repairs for Chromebooks will be processed by the Bonneville Joint School District 93 Technology Department.
DO NOT attempt to repair the Chromebook yourself.
Damaged Chromebooks should be brought to the school to initiate the repair process. In the case of loss/theft, a police report should be filed by the parent/guardian. A copy of the police report should be provided to the school Principal within seventy-two (72) hours.
Returning the Chromebook
Chromebook and power cords will be collected at the end of each school year. Failure to turn in a Chromebook will result in the student being charged the full replacement cost. Any student who transfers, withdraws or is expelled prior to graduation will be required to return his/her Chromebook and power cord upon termination of enrollment. Failure to turn in the Chromebook to the school office on the last day of attendance will result in the student being charged the full replacement cost of Chromebook, power cord and shipping costs.

Student Signature

*field type checkbox
I have read and understand the responsibilities of use of the school-owned equipment.
Student Signature*field type signature
Datefield type date

Parent Signature

*field type checkbox
I have read and understand the responsibilities of my child's use of the school-owned equipment and my responsibilities as the parent/guardian.
Parent Signature*field type signature
Datefield type date

Voluntary Chromebook Protection Plan Agreement

Terms and Conditions of the Voluntary Chromebook Protection Plan Agreement 2021-2022
The parent(s)/guardian(s) of all students may choose to enroll in a Voluntary Chromebook Protection Plan to help cover costs if the Chromebook is accidentally broken or damaged. The plan must be paid for within 7 days of the student checking out the Chromebook. The protection plan may not be purchased after damage has occurred to the Chromebook. The cost of the Voluntary Chromebook Protection Plan for a student is $20 annually (12 months) per device and is nonrefundable. There is a family maximum of $60 annually.
While there is no cost for the use of the Chromebook, it is imperative that each Chromebook that is issued to a student be maintained and handled in a responsible way. If the Voluntary Chromebook Protection Plan is not taken, the parent/guardian will be responsible to pay the total cost of whatever repairs are deemed necessary. If the damage is determined to be beyond repair, the charge may be the full replacement cost.
The Voluntary Chromebook Protection Plan safeguards you against accidental damage, such as unintentional liquid spills, drops, falls and/or other collisions.
The protection plan does not cover misuse, neglect, misplacement/loss, or intentional damage. The parent/guardian will be responsible for the entire cost of repairs or replacement of the Chromebook damaged through student misuse, neglect, intentional damage or loss. In case of theft, an official police report will be required. Multiple damage events may not be covered by this policy (more than two (2) damage claims in one year may be deemed neglect and not covered by this agreement).
The parent/guardian will need to purchase this protection plan through the school office before your student is allowed to check out a Chromebook or have indicated that they elect to decline the offered Voluntary Chromebook Protection Plan, in which case they assume full financial responsibility for the Chromebook including theft, loss or any damages.
It is highly recommended that parents/guardians take advantage of this opportunity. To enroll, check the appropriate box indicating you wish to enroll in the Voluntary Chromebook Protection Plan. If you choose not to enroll, check the box that states you do not intend to enroll in the plan. Payment for the plan can be made online through In-Touch or in person at the office where your child is attending. If you have already met your family maximum you do not need to pay additional money.
Payment must be received for the plan to take effect.

Voluntary Chromebook Protection Plan Coverage
What’s Covered
What’s Not Covered
Agreement Void
The agreement will become void for the current school year if:
Chromebook Parts Cost with and without Voluntary Chromebook Protection Plan
Replacement cost and parts cost reflect the current market price. The prices could fluctuate due to the current supply chain issues.
*field type radio button
I wish to participate in the Voluntary Chromebook Protection Plan.I do not wish to participate in the Voluntary Chromebook Protection Plan being offered by Bonneville Joint School District 93.

Parent/Guardian Signature*field type signature
Datefield type date

How to Pay

After submitting this form:
- Log into PowerSchool
- In TouchBase:

**There is a hold on this student's account and a Chromebook cannot be checked out at this time. Please contact your building secretary for more information.**

Hidden Section

Chromebook Part	Cost with Voluntary Protection Plan	Cost without Voluntary Chromebook Protection Plan
	All Models	Dell 3100	Asus	Acer
AC Power Cord	$0	$16.99	$16.99	$16.99
Battery	$0	$63.99	$59.99	$59.99
Keyboard	$0	$39.99	$39.99	$39.99
Non Touch Screen	$0	$47.99	N/A	N/A
Touch Screen	$0	$179.99	$279.99	$279.99
Motherboard/Headphone	$0	$199.99	$299.99	$299.99
Bezel	$0	$34.99	N/A	N/A
Main Body	$0	$49.99	$69.99	$69.99
Back Cover	$0	$41.99	$36.99	$36.99
Bottom Cover	$0	$19.99	$19.99	$19.99
Camera	$0	$19.99	$19.99	$19.99
Hinge Set	$0	$12.99	$29.99	$29.99

Chromebook Replacement	Cost with Protection Plan	Cost without Protection Plan
Full Replacement Cost for Damaged Device	$0.00	$385.00
Full Replacement Cost for LOST Device	$385.00	$385.00
Full Replacement Cost for STOLEN Device	$385.00	$385.00

School Yearfield type single line
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School Numberfield type single line
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DCIDfield type single line
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Current Userfield type single line
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Secretary Loginfield type single line
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Principal Namefield type single line
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Principal Loginfield type single line
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Principal Emailfield type single line
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Street Addressfield type single line
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Cityfield type single line
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Statefield type single line
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Zipfield type single line
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Laserfiche School Namefield type single line
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Last Initialfield type single line
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This field contains a calculation error.
References: Last Name

Network & DeviceUse Agreement

Student Signature

Parent Signature

Chromebook Checkout

Network & Device
Use Agreement