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Valley Stream 30 - Student Device Loaner Agreement Form
Please complete the form below and sign it by typing your full name where requested.
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* Indicates required question
Student - First name
*
Your answer
Student - Last name
*
Your answer
School
*
Clearstream Ave
Forest Road
Shaw Ave
Grade for the 2022/23 school year
*
kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Pre-K
Parent/Guardian - First name
*
Your answer
Parent/Guardian - Last name
*
Your answer
Please enter your phone number
*
Your answer
Do you currently have access to internet in your household?
*
Yes
No
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