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Student Name
Student Grade Level
School of Attendance
Parent/Guardian Name
Home Phone
Email Address
Loan Fee:
Full Pay Lunch Status - $30.00
Reduced Lunch Status - $15.00
Free Lunch Status - $5.00
The terms of this agreement include the following:

1. The dates of this agreement are listed above. All loaned items are to be returned promptly and in good working condition by the due date. This agreement may be rescinded at any time at the discretion of Pittsburg Community Schools, USD 250.

2. A technology use fee will be applied to students wishing to take their device home. Please see the district Fee Schedule for current technology use fees and how to pay.

3. All equipment and software shall remain the property of Pittsburg Community Schools, USD 250.

4. The Borrower and their Parent or Guardian accept responsibility for the equipment while it is in the Borrower’s possession. This includes both off-campus and on-campus use.

5. The Borrower must have a signed Acceptable Use Policy on file with the district and agrees to comply with all sections of the policy. By signing this agreement, Student and Parent or Guardian agree to utilize the device in accordance with the district’s Acceptable Use Policy. Violation of the district’s acceptable use policy can result in this agreement being rescinded.

6. The Borrower shall not attempt to upgrade, open, or make hardware modifications to any equipment.

7. The Borrower agrees to use an appropriate method of transporting the equipment and to keep the equipment secure at all times. Damage, loss, or theft must promptly be reported to the student’s teacher, Building/District Administrators, or District Technology Office.

8. The Borrower agrees that this property will be treated with care, with the understanding that the Student, Parent, or Guardian will be fully responsible for any costs associated with damage, loss, or theft, up to the cost of a replacement device.

9. Should a device be damaged or stolen, a replacement device may be made available on a daily check-in, check out basis until the costs to repair or replace the device has been paid to the school district.


10. Building and District Administration, including the District Technology Office, can restrict the student’s right to take home or use the device should this agreement or the district’s Acceptable Use Policy be violated or abused. This includes students who have paid the technology fee to take devices home.


11. By signing below, the Student and their Parent or Guardian indicate intent to use this equipment only for the purpose of facilitating the educational program of Pittsburg Community Schools, USD 250.

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