CONSENT TO STUDENT USE OF SCHOOL DISTRICT TECHNOLOGY,
NETWORK SYSTEMS, AND INTERNET ACCESS
I am the parent/guardian of the student named below and I hereby certify that I have received, read, and understand the school district’s Appropriate Use of Technology, Network Systems, and Internet Access policy.
I recognize that although the school district has taken measures to restrict access to controversial materials, it cannot guarantee that students will be protected from accessing any controversial materials during the student’s use of the school district’s technology, network systems, and internet access.
I accept full responsibility for my student’s use of the school district’s technology, network systems, and internet access through the school district in accordance with the terms, conditions, and guidelines as stated by the school district in its policies and regulations and as set out in federal and state law. I relieve the school district and its officers and employees, from any and all financial responsibility that may be incurred by my student’s use of the school district’s technology, network systems, and internet access.
STUDENT’S NAME:____________________________________________________________
GRADE: _______ My child may have access to the internet: _____ Yes _____ No
I hereby give the school district permission to publish my child’s work, picture,
and/or first name on the internet through the school district’s web site. _____ Yes ____ No
Parent or Guardian Name: _________________________________________________________
________________________________________ __________________
PARENT/GUARDIAN SIGNATURE DATE
If you have consented to your child’s use of the school district’s technology, network systems, and internet access, please have your child review and sign the following:
I have read the school district’s Appropriate Use of Technology, Network Systems, and Internet Access policy and agree to abide by its provisions. I understand that violation of these provisions will result in the restriction and/or termination of my ability to use the school district’s technology, network systems, and internet access and may result in further discipline up to and including expulsion and/or other legal action. I agree to be responsible for payment of costs incurred by accessing any internet services that have a cost involved.
_____________________________________
STUDENT SIGNATURE
