JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
MPS Optional Annual Insurance 2023-2024 (Grades 10-12)
It is
highly recommended
that families participate in an optional annual insurance program to provide coverage in case of loss or damage to the district-provided Chromebook. If you are not enrolled in this program, all costs associated with loss or damage to the device will be parents’/guardians’ responsibility. There is a $30 annual fee for the optional insurance program.
Please fill out this form for each student attending Maynard Public Schools in grades 10-12 whether or not choosing to sign up for insurance. No form or insurance is needed for students from pre-kindergarten through 4th grade. A separate form will be going out to families of students in grades 5-9.
Click here for more detail on the optional insurance program.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Student First Name:
*
Your answer
Student Last Name:
*
Your answer
Student Grade for 2023-2024 School Year:
*
Choose
10
11
12
Other
Most students going into grades 10-12 have an MPS Chromebook at home. Please provide the a
sset tag (barcode #) from the bottom of the Chromebook. Chromebooks not registered here will be locked before the start of school.
*
Your answer
Optional Insurance
*
I choose to enroll in the optional device insurance program for $30 (details on payment below)
I choose to waive participation in the optional insurance program
Parent Name indicating agreement to enroll or waive participation in the optional insurance program:
*
Your answer
Parent E-mail Address:
*
Your answer
Check this box to indicate financial hardship:
Financial hardship
If choosing to participate in the insurance program,
pay using MySchoolBucks by clicking this link
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Maynard Public Schools.
Report Abuse
Forms
