Fort Worth Independent School District Student Electronic Device Checkout Form
1. Electronic devices loaned or leased to students or staff shall be used only for educational purposes
that directly relate to a school project or assignment, unless otherwise explicitly authorized by
building administration.
2. Users are responsible for the proper care of electronic devices at all times, whether on or off
school property, including costs associated with repairing or replacing the device.
3. Users must report a lost or stolen device to the building administration immediately. If a device is
stolen, a report also should be made immediately with the local police.
4. The policy and rules apply to the use of the electronic device at any time or place, on or off school
property. Students are responsible for obeying any additional rules concerning care of devices
issued by school staff.
5. Violation of policies or rules governing the use of electronic devices or any careless use of the
device may result in a student’s device being confiscated and/or a student only being allowed to
use the device under the direct supervision of school staff. The student will also be subject to
disciplinary action for any violations of Board policies/procedures or school rules.
6. Parents are responsible for supervising their child’s use of the device when not in school.
7. The device configuration shall not be altered in any way by users. No software applications shall be
installed, removed, or altered on the device unless permission is explicitly given by the teacher or
building administrator.
8. The device is to be used only by the student or staff member to whom it is issued. The person to
whom the device is issued will be responsible for any activity or action performed on the device.
9. The device and accessories must be returned in acceptable working order whenever requested by
school staff.
This computer agreement is to signify that the above named student parent/guardian is fully
responsible for maintaining this device. It is agreed that FWISD 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 understand and agree to these device use guidelines and authorize my student to complete the
Device Checkout section on this form in order to checkout the device for the school year.
This device listed above has been scanned under your family’s name. You have accepted
responsibility for this device and all that is listed in this document.

Sign in to Google to save your progress. Learn more
Student First and Last Name *
Student ID *
Grade *
Parent's First and Last Name *
Phone Number *
Parent Email *
Parent's Driver's License Number/ Personal ID Number *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Fort Worth ISD. Report Abuse