PERRY COUNTY SCHOOL DISTRICT             STUDENT DEVICE ASSIGNMENT               PROGRAM RESPONSIBILITY FORM
The Perry County School District’s Student Device Assignment Program is an agreement made between the Perry County School District and the student and parent/guardian that the Device is assigned to.

The Device is restricted to student use for instructional purposes. Only Perry County School District-assigned accounts will be utilized on the device and student usage, including the internet and local account access, will be subject to web filtering and monitored by district staff at all times as required by law. It is the responsibility of the student and parent/guardian to ensure that the use of the device is in compliance with the Perry County School District’s Device Use Policy and Acceptable Use Policy.

By clicking "I agree" at the end of this form you are agreeing to the following statements:

- I have reviewed and agree to the Perry County School District’s Acceptable Use Policy.

- I understand that if I damage my Perry County School District issued device a first time that I am responsible for a $25 deductible for repairs.

- I understand that if I damage my Perry County School District issued device a second time I am responsible for a $25 deductible AND 25% of the repair cost.

- I understand that if I damage my Perry County School District issued device a third time I am responsible for the full cost of repair/replacement.

- I understand that if the device's charging cable is damaged, lost, or stolen, I am responsible for a $20 replacement fee.

- I understand that if the device is lost or stolen that I am subject to the replacement cost of the device.  This includes trading the issued device with another student and not turning in the device originally issued.

- I understand that the Device must be returned at the end of the school year or at the request of school district administration.



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Student's First Name *
Student's Last Name *
Grade Student is Entering *
Parent/Guardian's First Name *
Parent/Guardian's Last Name *
Do you agree to the above policies and procedures? Indicating "I disagree" will result in a Device not being issued to your student. *
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