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2022-2023 BCS 1:1 Device Form

By completing the form below, you and your child agree to all the policies and procedures you check or select. 


***This Page Must Be Filled Out For Each Child***

By reading, and acknowledging all points below you accept this form as substitution for in person and/or virtual orientation.

Child's School*
Answer Required



I understand that some objectionable materials may be accessed even with District content filtering in place.  I understand that individuals and families may be held liable for violations.  I will accept responsibility for guidance of Internet use by setting and conveying standards for my son/daughter to follow when exploring on-line information and media on an independent basis.  Bartlett City Schools cannot be responsible for ideas and concepts that my child may gain by his or her inappropriate use of the Internet.


I understand and accept the conditions stated and agree to release, indemnify, and hold harmless, the City of Bartlett, the Bartlett City Board of Education, and/or their employees or agents from any and all claims and liability associated with or arising from the above student’s independent use and/or access to the Internet.


As the parent or legal guardian of the minor student signing above or as a student 18 years of age or older, I have read this contract, the Student Responsible Use of Network and Electronic Media Agreement and the description of Wed Publishing and Media Coverage.  I grant permissions for this student in the following areas:

A. This student has permission to independently access the Internet (3rd grade and older).*
Answer Required
B. BCS has permission to publish this student’s image, likeness or work, on the Internet.*
Answer Required
C. BCS has permission to allow unrestricted media coverage of this student.*
Answer Required
Answer Required

Student Email Account Agreement


My signature below signifies my understanding that Bartlett City Schools email accounts are for educational purposes only and provided as a privilege by Bartlett City Schools. Any misuse of the Bartlett City School email system will result in immediate cancellation of my account. Malicious and/or illegal misuse of my email account, computer files or system network could result in legal prosecution. My signature below also signifies that I will not share my password with anyone.

As a student of Bartlett City Schools, I hereby state that I have read and understand the Use of Internet and Internet Safety Policy # 1021 as printed on the back of this form, and that I agree to comply with the provisions stated therein. 

I further state that I understand the following:

1.     Teachers, network and/or site administrators may review any files and communications to maintain system integrity and ensure that students are using the system responsibly. All student email is archived in accordance with Federal regulation.

2.     Files and any other information or communication stored on any electronic equipment owned or operated by Bartlett City Schools are not private and will not be maintained indefinitely.

3. Failure to abide by the terms of this agreement may result in disciplinary action up to criminal prosecution by government authorities.


Student Equipment Agreement Form

BORROWER’S AGREEMENT:  The borrower (student/parent named below) agrees to assume full responsibility for the safety, care, and maintenance of the device. While the device is in the borrower’s possession, the borrower agrees to abide by all BCS Policies. 

The device is the property of the school district, and as such, is subject to monitoring and search of contents at any time. Please note that the device is equipped with location tracking.  There is NO expectation of privacy in location, use, or data stored on the device. The device must be returned to the district immediately upon request, at the end of the year, or upon departure or termination from the District.

   While the equipment is in my possession, I agree to the following:

1.      I will take care of my device as identified in the Bartlett City Schools Device Procedures. 

2.      I will never leave the device unattended and understand that if found at school, I will be subject to discipline. If my device is damaged, lost, or stolen I will report it to the school immediately.

3.      I understand the device is my responsibility and I will not loan it to other individuals.

4.      I will know where the device is at all times.

5.      I will bring a charged device to school daily and will protect it by only carrying it in the protective backpack or sleeve.

6.      I will keep food and beverages away from my device since they may cause damage to the device.

7.      I will not disassemble any part of my device or attempt any repairs.

8.      I will use my device in ways that are responsible, appropriate, meet BCS expectations and are educational.

9.      I will NOT place decorations (such as labels, stickers, markers, etc.) directly on the device.  I will not deface the BCS device identifiers on my laptop. I will not write on the device for any reason.

10.     I understand that my device is subject to inspection at any time, without notice and remains the property of the BCS District. I will provide the device passcode and any passwords to staff, immediately upon request.  

11.     I will follow the policies outlined in the device Procedures and Use of the Internet and Internet Safety Policy # 1021 while at school, as well as outside the school day.

12.     I understand that I am subject to disciplinary action if inappropriate content is found on the device. 

13.     I will file a police report in the event of theft or vandalism. 

14.     I agree to return the District device, power cords, and any other accessories in good working condition.

 Typed Name below indicate that I agree to the stipulations above and as outlined in the Laptop Responsible Use, Policy, Procedures, and Information Guide.


Insurance and Lock
Answer Required

Parent Permission and Acknowledgement Form

My signature below identifies that I have read and understand the Bartlett City Schools Laptop Responsible Policy, Procedures and Information Guide and discussed the material with my child.


I understand my initials on the appropriate statement below identify how my student is to participate in the Bartlett City School’s 1:1 Device Program.


Please select only one option below

Option 1: I DO provide permission for my child to participate in the Bartlett City School’s 1:1 device program. I am aware that the provided device is owned by the Bartlett City Schools District. I am aware that the care and responsibility of the device as outlined in the Laptop Responsible Policy, Procedures and Information Guide both in and out of school lies with my child. I understand that a non-refundable Technology fee of $30.00/$50.00/$75.00 is due each year for my student’s device. I understand that other appropriate fees as outlined in the Laptop Responsible Policy, Procedures and Information Guide will be assessed in the event of damage, a lost laptop, or a theft. I understand that in the event of a lost laptop, I will assist in the search and if it is not found within three (3) days, a police report will be filed by the School Resource Officer. I understand that in the event of a theft outside of school, I must provide a police report. I understand that I am to provide a set of headphones and a lock for my student’s school locker if the school provides lockers.
Answer Required
Option 2: I DO NOT provide permission for my child to participate in the Bartlett City School’s 1:1 device program and the ability to bring home a device. I DO want my student to have a device available for use during the school day. I understand that my child is responsible for the completion of all assignments, which may include homework using the laptop. No Technology Fee will be required.
Answer Required
Option 3: I DO NOT provide permission for my child to participate in the Bartlett City School’s 1:1 device program or checkout a device. I want my child to complete course work through use of pen and paper. I understand that my child is responsible for the completion of all assignments. No Technology Fee will be required.
Answer Required