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2022-2023 Chromebook Insurance Form

JDCSS assigns each student his/her own Chromebook device at the beginning of each school year. For the 2022-2023 school year, we will be offering Chromebook insurance for a fee of $20 per student. This new Chromebook insurance is completely optional, but highly recommended. If you plan to purchase insurance, please complete the form below. The following are some guidelines for you to consider, when deciding if Chromebook insurance is the right choice for your family:

*Chromebook insurance is optional.

*Yearly fee of $20 covers any accidental repairs of your child's Chromebook.

*Intentional damage to a Chromebook is NOT covered by this insurance program.

*You can sign up for Chromebook insurance at any time during the school year.

*Your child must have a $0 balance owed on his/her Chromebook damages before buying insurance.

*Annual fee can cover multiple accidental repairs (according to severity).

*Without insurance, students will be required to pay full-price for damages.

*Click here for a list of Chromebook Damage Fees.

Student Information (Information for up to 4 children can be submitted at one time)

Child 1 (All fields must be completed)

First Name (Child 1)*

Answer Required

Last Name (Child 1)*

Answer Required

Grade Level for 2022-2023 (Child 1)*

Answer Required

Child 2 (All fields must be completed)

First Name (Child 2)

Answer Required

Last Name (Child 2)

Answer Required

Grade Level for 2022-2023 (Child 2)

Answer Required

Child 3 (All fields must be completed)

First Name (Child 3)

Answer Required

Last Name (Child 3)

Answer Required

Grade Level for 2022-2023 (Child 3)

Answer Required

Child 4 (All fields must be completed)

First Name (Child 4)

Answer Required

Last Name (Child 4)

Answer Required

Grade Level for 2022-2023 (Child 4)

Answer Required

Parent / Guardian Information

Parent's First Name*

Answer Required

Parent's Last Name*

Answer Required

Parent's Email*

Answer Required

Mobile Phone*

Number Required

Home Phone

Number Required

I, the undersigned, agree to comply with the Chromebook Insurance terms. I assume full responsibility for any and all possible damage which might occur (that is not covered by insurance, such as intentional damage to the device). I acknowledge that I have read and understand the Chromebook Insurance terms and guidelines.*

Answer Required

Yes, I agree to the terms listed above.

Quantity

Chromebook Insurance Fee*

A service fee of 4% + $0.35 will be added to the total purchase price.

Price: $20.00

Confirmation Email

Confirmation Email *

Email Required