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Is any damage or loss to the above items, fees will be charged to student s permanent fine account. OFFICE USE ONLY none none $150.00 Date: Date: Parent/Guardian Signature: Parent/Guardian Signature: Print Name: Print Name: *Insurance expires last day of 17- 18 school year White District Copy Yellow Parent/Guardian Copy Rev 5/16 Edmonds School District Summer Take Home and Chromebook Damage/Loss Program 2017-2018 School Year The educational program at your stud.

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