2015 calculator rental form

1. Baldwin Union Free School District
Mathematics Department
Calculator Rental Form
George Drakatos
Mathematics Supervisor, 6-12
Teacher Name: ________________________
Student Name: _________________________ Grade: ___________________
Please check only one of the following:
_____ I agree to my child borrowing a graphing calculator from the Baldwin Union Free School
District. I agree that I am responsible for this calculator and will make sure it is returned to the
teacher listed above at the completion of the course in working condition without any damage or
screen deformities. I will be responsible for replacing batteries as needed during the school year
and my child must bring the calculator to school each day since its use is integral in daily lessons,
homework, and assessments.
In case the calculator is lost, stolen or damaged, I will pay the full cost of the calculator ($66 for TI-
83+/TI-84+, $135 for TI-89, $152 for TI-Inspire) or replace it with a new calculator of the same
model.
If this calculator is not returned, replaced, or paid for, I understand that a cap/gown will not be
available for graduation, transcripts will not be sent to prospective colleges or other schools, and a
diploma will not be issued.
_____ I opt out of borrowing a calculator and will immediately provide my child with the appropriate
calculator for his/her mathematics class to use on a daily basis, in school and at home, as well as
for any state and local exams. I understand that if a calculator is not available, my child might not
be able to complete assignments, and his/her success in this class will be compromised.
Student signature: __________________________
Parent Name (Print): _____________________________ Parent Phone: ______________
Parent signature: ___________________________ Date: _________________
To be filled out by teacher:
Calculator Model (on front) ________________
Calculator Serial Number (on back) _________________________________________________