Parent or Guardian (If you are under the age of 18, a parent or guardian must also read and sign this agreement.)
As the parent/guardian of ____________________________________, I have read the Terms and Conditions for Internet access. I understand that this access is designed for educational purposes and the school system and the State Department of Education Office of Technology have taken available precautions to eliminate controversial material. However, I also recognize it is impossible to restrict access to all controversial materials acquired on the network. Further, I accept full responsibility for supervision if and when my child's use in not in a school setting.
I hereby give permission for my child to access electronic media and certify that the information contained on this form is correct.
Parent or Guardian (please print): _____________________________________________________
Signature of Parent or Guardian_________________________________ Date_________________________
Sponsoring Teacher (Must be signed if the applicant is a student)
I have read the Terms and Conditions and agree to promote this agreement with the student. Because the student may use the network for individual work or in the context of another class, I cannot be held responsible for the student use of the network. As the sponsoring teacher, I do agree to instruct the student on acceptable use of the network and of proper network etiquette.
Teacher's Name (please print):_________________________________________
Signature of teacher____________________________________________Date___________________
Application Portion of the Document
User's Full Name (please print):__________________________________________________________________
Home Address__________________________________ Home Phone/Work Phone________________________
I am (check one):
_____Student who will graduate in __________.
_____Teacher who teaches __________ in grade_______.
_____Staff Member working as _________________.