2020-2021 Madison Elementary School iPad Request Form
Please complete the following form if you are in need of a school issued iPad for virtual learning.  Please complete one form per student enrolled at Madison Elementary School for which an iPad is requested.

By submitting a request you are agreeing to the following terms of use:

-Take responsibility for technology provided and use the equipment for educational purposes only.

-Maintain the equipment in working condition while said equipment is in your possession.

-Return the equipment in the same working condition that you received it to designated personnel.

-Agree to and understand that if the technology equipment, software, and other related items are stolen, vandalized, misplaced, destroyed, etc. that you are responsible and will reimburse (pay) the District the amount required to replace or repair the equipment.  

There is no charge to borrow a school iPad, but there could be fees charged for damaged or lost items as follows:

Responsible party will be required to pay:
$25 replacement fee for lost/not returned or damaged lightning cable
$25 replacement fee for lost/not returned or damaged power adapter
Up to $500 replacement fee for broken, lost, or not returned iPads


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Email *
Please watch for further communication from Madison Elementary School regarding scheduled material pick-up days and times.  
Please complete one form for each child for which you wish to request a device.
Student Last Name *
Student First Name *
Student Grade *
Parent/Guardian Last Name *
Parent/Guardian First Name *
Do you have reliable internet access to connect the device(s)? *
Do you have access to adequate school supplies (pencils, crayons, etc.)? *
Parent Phone number: *
Full Address *
Equipment provided will be used for educational purposes only. *
Equipment must be maintained in working condition while said equipment is in your possession. *
Return the equipment in the same working condition that it was received it to the designated personnel. *
Agree to and understand that if the technology equipment, software, and other related items are stolen, vandalized, misplaced, destroyed, etc. that I am responsible and will reimburse (pay) the District the amount required to replace or repair the equipment. *
Up to $25 replacement fee will be charged for lost/not returned or damaged lightning cable *
Up to $25 replacement fee will be charged for a lost/not returned or damaged power adapter *
Up to $500 replacement fee will be charged for a broken, lost, or not returned iPad *
A copy of your responses will be emailed to the address you provided.
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