Acknowledgement of Receipt – Danvers Public Schools

Please complete and submit the form below. This form must be filled out and submitted for each student in your household that attends HRMS that
will be issued a Chromebook.

Chromebook Acknowledgement of Receipt

Student Name
First Last
LASID #
Year of Graduation
Device Serial Number
Signatures
Acknowledgement
- I have read and understand the terms of the Danvers Public Schools Chromebook guidelines, as well as the Holten-Richmond Responsible Use Policy
Parent/Guardian
First Last
Parent Signature
Date
MM slash DD slash YYYY
Acknowledgement
- As a student, my signature indicates that I have read and understand the terms of the Danvers Public Schools Chromebook guidelines, as well as the Holten-Richmond Responsible Use Policy. I accept responsibility for abiding by the terms and conditions outlined in those documents.
Student Name
First Last
Student Signature
Date
MM slash DD slash YYYY

Chromebook Acknowledgement of Receipt

Signatures

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