Technological Equipment Acknowledgement Form

iPad Equipment Receipt Acknowledgement
Student Name
First NameLast Name
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Date of birth
MonthDayYear
Date
Class Name
Equipment Details
Modal of iPad
Did you receive Charging Cable?
YesNo
Did you receive Charging Brick?
YesNo
Did you receive iPad Case?
YesNo
By initialing next to each item and signing the iPad Equipment Receipt Acknowledgement form, I verify that my child has received all items below that have been issued to him/her. I also understand that at the end of the current school year my child will return all iPad equipment issued to him/her back to school.
Guardian Signature
DateTime
Should be Empty:

iPad Equipment Receipt Acknowledgement