SCOTT COUNTY
SCHOOL DISTRICT 1
AUGUST 2003
This agreement must be completed
by anyone requesting access to the Internet through Scott County School
District 1. The agreement is required
for adults and students alike. This
agreement is binding on all users who sign it, whether they are accessing the
Internet through equipment provided by Scott County School District 1 or through
private access. This agreement will
need to be signed at the entrance of each school level (Elementary, Middle,
High School) and will be in effect until the student enters the next building
level or until his/her rights are suspended for disciplinary purposes.
NAME:
ADDRESS:
TELEPHONE:
I, acknowledge that I have received a copy of
the Internet Use Policy for Scott County School District 1 and that I have read
that policy and understand the terms outlined for accessing the Internet. I also acknowledge that any violations of
the policy as written may result in the cancellation of my access
privileges. As a student of Scott
County School District 1, I further acknowledge that misuse of the Internet
will result in appropriate disciplinary and/or legal action.
User Signature: Date:
PARENT OR
GUARDIAN STATEMENT
(To be completed
for all users under the age of 18)
As a parent or guardian of the above named individual, I
have read the Internet use policies of Scott County School District 1 and I
understand and agree to their provisions.
I also acknowledge that there are resources available on the Internet
that may be considered to be inappropriate.
I acknowledge that I will not hold Scott County School District 1 or its
employees responsible for any materials acquired on the Internet. I further accept full responsibility for the
supervision if and when the above named individual is not in a school
setting. I hereby give my permission
for Internet access to be established for the above named person. I also acknowledge and certify that the
information contained on this form is correct.
Parent or Guardian's Name:
Signature Date: .