CMCHS CHROME BOOK / CALCULATOR CHECKOUT FORM
The district has provided a Chromebook and/or Calculator for student use. It is the student’s and parent/guardian’s responsibility to ensure that the wireless device is not misused or neglected while it is in his/her care and that necessary precautions are taken to avoid theft, damage, or loss of the Chromebook.

The Chromebook is assigned to the enrolled Cato Middle College High School student for academic use only. Students should refrain from using the device for personal reasons and social media purposes. Students should not use the device to access inappropriate sites, whether at school or at home.

Students will be held liable for inappropriate use and the loan agreement will be revoked.

By completing this form, the student and parent/guardian are accepting the responsibility for the Chromebook, serial number _____________________ or Calculator number _____________ (This section will be completed by CMCHS Principal, Administrative Secretary, or Technology Facilitator)

The device must be returned by August 3, 2023 or before the summer graduation if you graduating.

Should the device be lost or stolen, the student and parent/guardian understand that a financial obligation of $50 will be assessed and must be paid prior to the new semester.

Should the device be damaged, the student and parent/guardian understand that a financial obligation of $15 will be assessed and must be paid prior to the new semester.

NOTE: $10 fee for chargers and $5 fee for Misc. (lost part of device)

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Student's Last Name *
Student's First Name *
CMS ID # *
Student's Grade *
Student's CMS Email *
Student's CPCC Email *
Student's Personal Email *
Student's Cell Phone # *
Parent / Guardian First & Last Name *
Parent / Guardian Contact Phone # *
Parent / Guardian Email *
The device I am checking out for the summer:
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I have read and understand the Chromebook / Calculator Checkout Form *
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