Caddo Parish Schools Department of Special Education
Agreement for Loan of Caddo-Owned Assistive/Adaptive Equipment
Caddo Parish Schools will provide maintenance and repair for assistive/adaptive equipment due to ordinary wear of a piece of equipment. Per senate Bill (SB) 87, the Caddo Parish School District is not required to
repair or replace assistive/adaptive technology devices if the device has been lost, stolen, damaged, broken, or otherwise misused while in the possession of the child, parent, or guardian.
Student Name: Date Equipment was Issued:
School Attending: Date Equipment Returned:
Equipment Condition Replacement Equipment Condition
Equipment/Accessory Description Tag # / Serial # at Time of Issue Cost of at Time of Return Comments
Check () One Equipment Check () One
New Good Good Fair Damaged
My child and I are requesting the loan of the above stated assistive/adaptive equipment. We acknowledge and agree to the following conditions:
To return the assistive/adaptive equipment as requested by the authorized Caddo staff member.
To reimburse as requested to Caddo Parish Schools the repair cost of the loaned equipment should it become damaged or broken while in the possession of my child or myself.
Parent/Guardian’s Signature for acknowledgement of receipt of equipment and knowledge of maintenance and repair agreement:
Parent/Guardian Signature: Parent/Guardian Name:
Address: Telephone Number:
(City, State, Zip) (Cell or Work)
SPC Authorized Staff Signature: Immediate Supervisor’s Initials:
(HI, VI, APE, OT, PT, Speech, ATRC, Other)