The undersigned acknowledges receipt of an Apple MacBook computer,
Asset tag number ___________________________________________.
(Choose one of the following plans)
The undersigned acknowledges responsibility for the computer’s safekeeping and that loss of or damage to the computer will require the payment of a $250 deductible per incident payable to the Pinckney Community Schools. Loss of the computer will require that the responsible party file a report of loss and/or theft with the local law enforcement agency. Damage to the computer must be reported promptly in writing to the school office.
I, the undersigned, wish to limit liability in the event of loss of or damage to the issued computer. I wish to take advantage of the District’s self-insurance policy by making a annual, non-refundable payment of $50.00 to the insurance pool. I understand that this payment will eliminate my responsibility for loss or damage (except as a result of negligence or abuse) to the issued computer.
I further understand that a second incident of loss or damage to the computer may result in the suspension of the privilege to have full access to the computer and my use of a district-issued computer will be limited to hours in which school is in session.
Office Use Only
Amount Received _____________ Date ___________________
Received by _______________