Student Name ____________________________ Year of Graduation _______

School ____________________________

I have read the Internet Acceptable Use Policy for Grades 6-12. I agree to follow the rules contained in this Policy. I understand that if I violate the rules my account can be terminated and I may face other disciplinary measures.

Student Signature __________________________ Date ________________

I have read the Internet Acceptable Use Policy for Grades 6-12.

I hereby release the district, its personnel, and any institutions with which it is affiliated, from any and all claims and damages of any nature arising from my child’s use of, or inability to use, the District system, including, but not limited to, claims that may arise from the unauthorized use of the system to purchase products or services. I understand that I can be held liable for damages caused by my child’s intentional misuse of the system.

I will instruct my child regarding any restrictions against accessing material that is in addition to the restrictions set forth in the Internet Acceptable Use Policy. I will emphasize to my child the importance of following the rules for personal safety.

I give permission to issue Internet Access for my child.

Parent/Guardian Signature __________________________Date _______________

Parent/Guardian Name ________________________________

Home Address __________________________ Phone ________________