Thu, 31 Jul 2008 11:42:42 -0500 5.2.0.0.0309 1.0 Davis, Jane E Form Letter Laptop Form Students

Inches Letter 8.5 11 Portrait 0.75 0.5 0.5 0.5 100 Times 10 13 <center>HERSHEY PUBLIC SCHOOL COMPUTER LOAN AGREEMENT</center> DATE CHECKED OUT:<tabl 3.5>August 20, 2007 DATE OF RETURN:<tabl 3.5>On or before May 18, 2008 STUDENT NAME:<tabl 3.5>^(First_Name) ^(Last_Name) GRADUATION YEAR:<tabl 3.5>^(graduation_year) PARENT(s) NAME:<tabl 3.5>^(father)/^(mother) HOME PHONE:<tabl 3.5>^(Home_Phone) ADDRESS:<tabl 3.5>^(Mailing_Street), ^(mailing_city), ^(mailing_state) PARENT E-MAIL ADDRESS:<tabl 3.5>^(GuardianEmail)_____________________________________ Item Description:<tabl 3.5>#/Laptop<tabl 5.5>Condition Laptop Computer SN:<tabl 3.5>^(laptop_serial_number)<tabl 5.5>New Laptop Asset Tag#:<tabl 3.5>^(laptop_asset_tag) Charger:<tabl 5.5>New Carrying Sleeve:<tabl 5.5>New The above listed items are being leased to me and are in good working order unless otherwise indicated. It is my responsibility to care for the equipment and ensure that it is retained in a safe environment. A $25.00 fee is assessed to cover the use of the computer for the 06-07 school year. This fee is non-refundable. Students will be responsible for purchasing any accessory computer equipment and replacment cost will be up to the student (ex. Mouse, head phones, CDs, disks, etc....). The equipment is the property of Hershey Public School of Hershey, NE and is herewith being leased to the student/parent for educational purposes only for the Academic School Year. Students may not deface or destroy this property in any way. Inappropriate material on the machine may result in the student losing their right to use this computer. The equipment will be returned to the school on a date to be requested or sooner if the student is discharged from the school prior to the end of the school year. If the laptop is intentionally damaged while in the student's possession, the student/parent is responsible for the replacement or repair as stated in the student handbook under school property. The student/parent agrees to indemnify the District against any loss occurring during or resulting from student's possession or use of laptop, including, but not limited to any claim for infringement or violation of applicable trademarks and copyrights attributable to student's use of District Property. The laptop may be used by the student/parent only for non-commercial purposes, in accordance with the District's policies and rules. Any included software may be used only in accordance the applicable license and it is the student/parent's responsibility to be familiar with and to comply with the provisions of such license. Student/parent may not install or utilize any software in connection with the use of the laptop other than the software owned by the District and made available to the student/parent in accordance with this computer loan agreement. The student/parent also agrees not to make any unauthorized use of or modifications of such software. The student/parent acknowledges and agrees that their use of the laptop is a privilege and that by this agreement, the student/parent acknowledges the student's responsibility to protect and safeguard the laptop and to return the same in good condition and repair. The District hereby acknowledges receipt of the sum of $ 25.00 from student and/or parent - legal guardian in consideration of the use of the Distict Equipment and as a user fee to secure the timely return thereof in good condition and repair. Parent's Signature _________________________ Print Name _________________________________ Student's Signature_________________________Date:_______ Signature of School Administrator:__________________________________________