• Millersburg Area School District (MASD)

    Pledge for Student Device Use & Insurance Form


    • I will use and care for my Device responsibly as described in the Acceptable Use Policy while at school and at home.
    • I understand that a District Device is subject to inspection at any time without notice and remains the property of the Millersburg Area School District.
    • I will never leave the Device unsecured or unattended, and I am responsible for knowing the location of my Device at all times.
    • I will not use stickers, markers, etc., on a District Device or do anything to permanently alter the Device.
    • I will password protect my Device and never loan out my Device or give my password to other individuals.
    • I will not let anyone else use my Device other than my teachers, administrators, or parents/guardians.
    • I will charge my Device’s battery daily and arrive at school with my device charged.
    • I will keep food and beverages away from my Device since they may cause damage to the device.
    • I will clean the Device’s screen with a soft, anti-static cloth only, using no cleaners.
    • I will not disassemble any part of my District Device or attempt any repairs.
    • I will not remove or deface the serial number or other identification on any District Device.
    • I will cooperate in the filing of a police report in case of theft, vandalism, or other acts covered by insurance and inform my building administrators.
    • I will be responsible for all damage to, or loss of the Device, caused by neglect or abuse.
    • I agree to return the District Device and power cords in good working condition.


    Select One


    ____   Device Insurance: $25.00 - Checks payable to <NAME>

    ____   Opt Out - I have reviewed the stated Pledge for Device Use and Acceptable Use Policy and choose to opt OUT of the District’s insurance. Since insurance is not being purchased, I understand that I will be financially liable for the full replacement or repair cost as determined by the Technology Department and building principal.




    ____________  ________________________________   ______________________________________

            Date                             Signature of Student                                         Printed Name of Student



    ____________  ________________________________   ______________________________________

           Date                      Signature of Parent/Guardian                      Printed Name of Parent/Guardian