COMPUTER LOANER Form

1
Student 1: Name* This field is required.STUDENT 1: You will list all Student Names of ENROLLED students at all ODYSSEY CHARTER SCHOOLS
LAST Name
FIRST NAME
2
Student 1: Student ID Number* This field is required.STUDENT 1: List all Student ID#
3
Student 1: School at Odyssey* This field is required.Choose the school that Student 1 attends at Odyssey
Elementary School
Middle School
High School
4
Do you have any other students enrolled at Odyssey Charter School
YESNO
5
ADDITIONAL ODYSSEY STUDENTS
Student 2
First Name     Last Name
Student 3
LAST Name     FIRST Name
Student 4
First Name     Last Name
Student 5
First Name     Last Name
6
Parent/Guardian Name* This field is required.Please give the name of the parent/guardian that will be responsible for the computer
LAST Name
FIRST Name
7
Parent Email* This field is required.
example@example.com
8
Parent Phone Number* This field is required.
Please enter a valid phone number.
9
Conditions of computer loan:
I understand that if I withdraw my student from Odyssey the computer will be given back at the time of withdrawl in the same condition it was loaned.
I understand that any software or hardware installed on this computer must be approved by the technology department
I am responsible for an internet service provider (IEP) and any changes that may occur.
I understand that if this computer fails, I will have to go back on the waiting list to receive another loaner computer.
I am responsible for monitoring all internet activity on this computer while it is in my possession.
I understand that if I don't return this computer back to the school, OCS reserves the right to report it stolen to the police department.

Parent/guardian Signature *
10
Today's Date* This field is required.PRESS SUBMIT TO BE ADDED TO OUR COMPUTER LOANER LIST
Date
Month
Day
Year
Should be Empty: