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2021-2022 Student Device Agreement Form
Please complete one form per student. The optional non-refundable student device protection plan is $15 for the 2021-2022 school year. Students who are approved for free or reduced lunch status will have the option to pay a reduced non-refundable $5 student protection plan for the 2021-2022 school year. Students who do not purchase the protection plan will be liable for all expenses for repair. Payment for the student device protection plan is accepted at the time the student device is issued to the student. Parents/Guardians/Students may bring a check (payable to Schuylkill Valley School District) or cash for payment of the student device protection plan to your device distribution appointment or pay online in advance of device pick up at:
https://bit.ly/2122protectionplanonlinepayments
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* Indicates required question
Student's Last Name:
*
Your answer
Student's First Name:
*
Your answer
Cafe Pin:
Your answer
Grade:
*
Choose
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
School:
*
Elementary School
Middle School
High school
Parent/Guardian Name:
*
Your answer
Email Address:
Your answer
Telephone:
*
Your answer
For Parents/Guardians - By initializing below (add initials), I am acknowledging to provide permission for your child to receive a District-issued iPad/Chromebook.
*
Your answer
Repair Cost Schedule with Protection Plan
1st Incident of damage: No charge
2nd Incident of damage: $50
3rd Incident of damage: Full repair cost
Theft, loss, damaged beyond repair: Cost of a new device
Student Device Use Options
*
** Please note, without the Student Device Protection Plan the full cost of repair or replacement is due. Repair Cost Schedule may be found at:
https://bit.ly/costschedule
Purchasing protection plan
Not purchasing protection plan **
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