Homeroom Teacher: ____________________Grade: _________

Student Signature: ______________________Date: __________

Parent or Guardian: As the parent or guardian of this student, I have read the Internet Use Agreement found on this site. I understand that this access is designed for educational purposes. I recognize it is impossible for the school to restrict access to all controversial materials, and I will not hold the school district responsible for materials acquired on the Internet. I hereby give permission for my child to have access to the Internet while at school. My child responsible for the equipment that my child uses in the classroom and my child will only use the equipment assigned to my child when they are allowed to use it. Failure to follows these rules will result in the loss of this privilege for a stated period of time. I have discussed this policy with my child, as well as reviewed this website with my child. We will follow these rules to be good digital citizens.  

Parent or Guardian’s Name: Please Print: __________________________________________

Signature: ____________________________________________ Date: ___________________


A paper copy of this signed form will be kept in the teacher's classroom for the duration of the school year. No students will be allowed access to the internet until the paper form has been signed and returned to school.