RBCSD Insurance Claim Form
The RBCSD Insurance Claim Form should be completed if the device is not working properly, broken, or misplaced. The damaged device must be presented to the high school office along with the claim form and possible payment of deductible. A replacement device will be issued once all paper work and payment are completed.
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Email *
Today's Date *
MM
/
DD
/
YYYY
Student First Name *
Student Last Name *
Year of Graduation *
Contact Number *
Address *
Please explain the issue with the device *
Submit
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