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Prescott Library at the Wheeler School
Amazon Kindle Permissions and Acceptable Use Form
Introduction
The Amazon Kindle is a convenient, portable reading device. It is the size of a paperback and capable of
holding up to 1,500 books. A student can highlight sections of text, make notes anywhere in the text, or
even make a clipping of the entire page if desired – it all shows up under ‘clippings’, for easy retrieval
later. In addition, unfamiliar words can be instantly defined using the onboard dictionary. The chance to
use this device is a privilege that we are able to provide to students provided that the students use extra
caution and responsibility. Each Kindle is valued at $175.00. For this reason we require a parental
signature before a Kindle can be loaned to a student.

Student Responsibilities and Permission
I agree to take care of the Prescott Library Kindle and comply with Wheeler School Policies as well at its
Acceptable Use Policy* while it is in my possession. I will not:
     o Intentionally throw, drop, or damage the Kindle in any way
     o    Remove the Kindle from its protective case
     o    Give the Kindle to another student for his/her use
     o    Download, purchase, or remove the content loaded on the Kindle
     o    Leave the Kindle unsupervised (on desk, in hall, in car, etc.)
I agree to return the Kindle in good condition at the conclusion of the two week loan period.
STUDENT NAME (printed) ______________________________________________                        Graduation Year: ________________

STUDENT SIGNATURE __________________________________________________                         DATE: ___________________________


Parent Responsibilities and Permission
I am authorizing the use of a Prescott Amazon Kindle to my child. I understand that it is to be used as a
tool for reading and learning and that my child will comply with the Wheeler School Acceptable Use
Policy*. I will help ensure the safe and timely return of the Kindle within the loan period of two weeks. I
also understand that I am financially responsible for any willful, malicious, or accidental damage to the
Kindle as well as any charges resulting from content downloaded to the Kindle. I understand that my
child may lose future loan privileges of the device if the Kindle is either damaged or not returned in a
timely manner.

GUARDIAN NAME (printed) __________________________________________________________________________________

GUARDIAN SIGNATURE__________________________________________________                         DATE____________________________

GUARDIAN CONTACT INFO (phone and email): ____________________________________________________________




Media Center Staff Only

Date Permission Slip Received:______________________________________________
Media Center Specialist Signature: __________________________________________




This form adapted with permission from an original creation by school librarian Buffy Hamilton at
http://www.theunquietlibrary.libguides.com/content.php?pid=165142&sid=1392971
*Wheeler’s Code of Conduct and Internet Acceptable Use Policy are available in the Student & Parent Handbook.

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E reader checkout consent form

  • 1. Prescott Library at the Wheeler School Amazon Kindle Permissions and Acceptable Use Form Introduction The Amazon Kindle is a convenient, portable reading device. It is the size of a paperback and capable of holding up to 1,500 books. A student can highlight sections of text, make notes anywhere in the text, or even make a clipping of the entire page if desired – it all shows up under ‘clippings’, for easy retrieval later. In addition, unfamiliar words can be instantly defined using the onboard dictionary. The chance to use this device is a privilege that we are able to provide to students provided that the students use extra caution and responsibility. Each Kindle is valued at $175.00. For this reason we require a parental signature before a Kindle can be loaned to a student. Student Responsibilities and Permission I agree to take care of the Prescott Library Kindle and comply with Wheeler School Policies as well at its Acceptable Use Policy* while it is in my possession. I will not: o Intentionally throw, drop, or damage the Kindle in any way o Remove the Kindle from its protective case o Give the Kindle to another student for his/her use o Download, purchase, or remove the content loaded on the Kindle o Leave the Kindle unsupervised (on desk, in hall, in car, etc.) I agree to return the Kindle in good condition at the conclusion of the two week loan period. STUDENT NAME (printed) ______________________________________________ Graduation Year: ________________ STUDENT SIGNATURE __________________________________________________ DATE: ___________________________ Parent Responsibilities and Permission I am authorizing the use of a Prescott Amazon Kindle to my child. I understand that it is to be used as a tool for reading and learning and that my child will comply with the Wheeler School Acceptable Use Policy*. I will help ensure the safe and timely return of the Kindle within the loan period of two weeks. I also understand that I am financially responsible for any willful, malicious, or accidental damage to the Kindle as well as any charges resulting from content downloaded to the Kindle. I understand that my child may lose future loan privileges of the device if the Kindle is either damaged or not returned in a timely manner. GUARDIAN NAME (printed) __________________________________________________________________________________ GUARDIAN SIGNATURE__________________________________________________ DATE____________________________ GUARDIAN CONTACT INFO (phone and email): ____________________________________________________________ Media Center Staff Only Date Permission Slip Received:______________________________________________ Media Center Specialist Signature: __________________________________________ This form adapted with permission from an original creation by school librarian Buffy Hamilton at http://www.theunquietlibrary.libguides.com/content.php?pid=165142&sid=1392971 *Wheeler’s Code of Conduct and Internet Acceptable Use Policy are available in the Student & Parent Handbook.