ACA: Equipment Checkout Form.

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Equipment Loan Agreement Form

This form assigns primary responsibility for Antioch Charter Academy equipment to the borrower. The borrower will be responsible for taking necessary precautions to protect the equipment, and to store it in a manner that provides adequate protection when it is not in use, thus not subjecting the equipment to possible damage or theft. Fill out one form for each child/student.

If the equipment is damaged from misuse, lost, or stolen the borrower agrees to reimburse Antioch Charter Academy for replacement.
Chromebook $300-$350 (depending on model)
Cord $25
Mouse $10
Headphone $10-$20 (depending on model)
Instruments (See Instrumental Agreement). ONLY for returning students. DO not fill out if a new student.
Other: (Replacement costs will vary)

Equipment cannot be loaned or transferred to a 3rd party.
Equipment is for school use only.
The borrower agrees to return the equipment in like condition it was received.

Email *

Name of Parent/Guardian (Borrower): *

Name of Student: *

Equipment Borrowing: *

Mark if YES

Mark if NO

Chromebook Bundle

Instrument

Other

I realize I will receive a Chromebook BUNDLE, which will include. Chromebook, charging cord, headphones, and mouse.

YES

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What INSTRUMENT are you checking out for your child?

What OTHER are you checking out for your child?

I ACCEPT responsibility for care and return of the equipment. If the equipment is damaged from misuse, lost, or stolen the borrower agrees to reimburse Antioch Charter Academy for replacement. *

I AGREE

A copy of your responses will be emailed to the address you provided.

Submit

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