Danbury ISD * COVID-19 * Device Request for Distance Learning

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Our priority is to provide devices for those students that currently do not have devices at home for distance learning. All devices checked out during this period must be returned when students return to campus or upon the request of DISD staff. This form must be filled out separately for each child attending DISD if a device is needed. Once the form is completed then a DISD employee will contact the Parent/Guardian. Our goal is to accommodate as many requests as possible. Thank you!

Parent/Guardian Name *

Please provide the name of the parent/guardian that will pick up the equipment. The parent/guardian will be verified through our Student Information System and ID will be required at the time of check-out.

Parent/Guardian Email *

Parent/Guardian Phone number *

Student's First Name *

Student's Last Name *

Student's School *

Danbury Elementary School

Danbury Middle School

Danbury High School

Do you have internet or access to the internet at home? *

Yes

Smart Phone only

Required

Parent/Guardian Acknowledgment

Acceptable Use Policy *Parents/Guardians must verify that they have read District AUP relating to safety and acceptable use of the school district computer system and the Internet. www.danburyisd.org/stuaup/ *

As the parent or guardian of this student, I have read the school district AUP relating to safety and acceptable use of the school district computer system and the Internet. I understand that this access is designed for educational purposes. The school district has taken precautions to eliminate controversial material. However, I also recognize it is impossible for the school district to restrict access to all controversial materials and I will not hold the school district or its employees or agents responsible for materials acquired on the Internet.

Required

I understand and agree to the following conditions for borrowing a Chromebook device: * *

The device is the property of Danbury ISD. It is provided for school-related use only by the student designated on this form or school-aged sibling in the household. The device must be used in a responsible manner and every precaution will be taken to prevent damage to it. The device will be returned at the end of the school year. Additional information will be sent if this break has been extended.

Required

I understand that I will cover the $25 cost for insurance for the device *

Yes

If this fee is a hardship, please contact your campus principal

Questions or Comments

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Danbury ISD. Report Abuse

Forms