__________________________________________________________________
__________________________________________________________________
Spring Summer ___
___ ________________________________________________ : Date Signed out:
KRC PARAMEDIC PROGRAM iPAD
SIGN-OUT APPLICATION
STUDENT INFORMATION
Name __________________________________________________________________
Student ID
Phone Number
iPad Informaon
Serial Number
Semester Fall Year _
Date Due __________________________________________________________________
Read and Sign
I agree to return the iPad referenced above in good condion no later than the last day of the semester for
which it is checked out. If I fail to do so, my student account will be charged the enre replacement cost of
$600.
When the iPad is returned, it will be thoroughly examined by KPC staff for any signs of damage or missing
components. If anything is found to be faulty, I will be billed the enre replacement cost of $600.
I will be ineligible to register or receive transcripts unl the iPad is returned or its full replacement cost paid.
If my account is turned over to a collecon agency, I will be responsible for the cost of the iPad plus any addional
cost of collecon.
I am responsible for backing up all the files recorded by the iPad. Upon return, any informaon captured on
the iPad will be erased. KPC is not responsible for data loss.
Signature
Signature:_ Date Returned:
KPC USE ONLY
iPad, USB, Protecve Case and Instructions are included at Checkout & Return
Circle One Ye s No
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