Middlesex County Academy for Science, Mathematics and Engineering Sciences
Texas Instruments TI-84 Plus Calculator Agreement Form
Mrs. Michelle Gomes email@example.com (732) 452-2600
This form must be printed,completed and returned as a form of record for the agreement of the terms below.
I request the use of the following equipment for the dates and purpose(s) outlined below:
Texas Instruments TI-84 Plus Graphing Calculator
Dates: from ________________till June 20__
In consideration for the privilege of borrowing the graphing calculator during my high school tenure at the Middlesex Academy, I understand and acknowledge that I am responsible for this calculator while it is in my custody and control, and agree to return the calculator in the same condition in which it was received. I agree to the replacement of 4 “AAA” batteries as needed are my responsibility. In the event that it is damaged or stolen, I understand that I will be held financially responsible for replacement of the identical model TI-84 Plus at the current value at the time of loss or return of the calculator..
Parent or Guardian Printed Name__________________________________________________