Parent- Request Form for School-Issued Device

My child attends    Please Select Castle Heights Middle School Dutchman Creek Middle School Rawlinson Road Middle School Saluda Trail Middle School W.C. Sullivan Middle School Raven Aspire *   

My child is in the    Please Select 6th 7th 8th Aspire (9-12) *   grade.

I request for my child, First Name*   Last Name*   , to bring home his/her school issued laptop for the purpose of    Please Select Prolonged illness Time to complete project, essay, etc Absences from school *    for the time frame of   Date*   through   Date*  (not to exceed 5 consecutive school days) .

*I understand that the parent/student is responsible for the care of the laptop, charger, and case, including physical mishandling and accessing unauthorized sites. I may incur financial penalties if the laptop is intentionally damaged under my care.

Technology Charges:
Damaged Keyboard $85
Damaged Touchscreen $85
Case $20
Charger $40
Computer Replacement:
Less than a year old $670
Greater than a year old $504
Greater than two years old $336
Greater than three years old $168

*It is the responsibility of the parent and student that the laptop is brought to school each day although the student has permission to the laptop home.

*Timeframe should not extend five consecutive school days. A new request should be completed if further time is desired. 

Parent   First Name*   Last Name*   
Parent Email   Email*   
Parent Phone Number   Area Code*   Phone Number*