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Escalon USD Chromebook Insurance Opt-in/Out Form - 2023/24 School Year

Escalon Unified School District has contracted with Securranty to underwrite insurance for your child's take-home Chromebook. The policy provides comprehensive coverage and zero deductible, to include:

- Extended Warranty: Mechanical Breakdown

- Accidental Damage: Cracked Screens, Spills, Liquid Submersion, Accidental Drops

- Theft (Police Report required) & Standard Perils: Flood, Fire, Natural Disaster, Vandalism, Power Surge

- Loaner Devices are provided until repair or replacement is processed (loaner devices are not insured by Escalon USD and carry personal liability).

Please complete this form for EACH CHILD (grade 3 and above) enrolled in Escalon Unified School District.

Submission of this form confirms acceptance of all clauses indicated in the form and measures found in the District Mobile Device Handbook.

Verification of a completed form is REQUIRED at the beginning of the school year before a district Chromebook can be issued to a student.

Student Last Name:*

Answer Required

Student First Name:*

Answer Required

Student ID:*

Answer Required

School Attending for 2023/24 School Year:*

Answer Required

Grade Level for 2023/24 School Year:*

Answer Required

Parent(s) Name:*

Answer Required

Parent E-Mail Address:

Answer Required

Primary Phone:*

Answer Required

Mailing Address:*

Answer Required

City, State, ZIP:*

Answer Required

Device Coverage Selection:*

Secure online payment can be made here via credit or debit card

Answer Required

$23.70 - I AGREE to select coverage for the remainder of the 2023/2024 school year

$0.00 - I DECLINE coverage, and I understand that if I agree to not insure my child’s device, I thereby accept any and all liability for damages, and shall be billed accordingly

Confirmation Email

Confirmation Email *

Email Required