We are sending you this Parental/Guardian Consent Form to both inform you and to request permission for your
child's photo/image and personally identifiable information to be published on the district and/or
school's web site.
As you are aware, there are potential dangers associated with the posting of personally identifiable information on a web site since global access to the Internet does not allow us to control who may access such information. These dangers have always existed; however, we as schools do want to celebrate your child and his/her work. The law requires that we ask for your permission to use information about your child.
Pursuant to law, we will not release any personally identifiable information without prior written consent from you as parent or guardian. Personally identifiable information includes student names, photo or image, residential addresses, e-mail address, phone numbers and locations and times of class trips.
If you, as the parent or guardian, wish to rescind this agreement, you may do so at any time in writing by sending a letter to the principal of your child's school and such rescission will take effect upon receipt by the school.
Check one of the following choices:
I/We GRANT permission for a photo/image that includes this student without any other personal identifiers to
be published on the school and/or district's public Internet site.
I/We GRANT permission for this student's photo/image and name to be published on the school and/or
district's public Internet site.
I/We GRANT permission for this student's photo/image and all other personal identifiers listed above to
be published on the school and/or district's public Internet site.
I/We DO NOT GRANT permission for photo/image that includes this student to be published on the school and or
district's public Internet site.
Student's Name: (please print) ________________________________________________________________
Student's School: __________________________________________________________Grade: ____________
Print Name of Parent/Guardian: (print) ___________________________________________________________
Signature of Parent/Guardian: (sign) _____________________________________________________________
Relation to Student: ___________________________________________________________________________
Date: ___________________________________________
Technology and Network Access
The [ - ] School District provides students with access to computer equipment, software, and network services. These tools support learning, collaboration, and educational research related to the district curriculum. All technology and network usage must be consistent with these purposes, the Responsible Use Policy, and all provisions of law governing the actions of the user.
The Internet, however, is not designed exclusively for the use of children. While its use in district schools will be subject to supervision, it is possible that students may occasionally access inappropriate material either deliberately or by accident. District guidelines for Internet use prohibit access to material that is inappropriate in the school environment. We encourage parents to have a discussion with their children about values and responsible behavior while using the Internet. Parents wishing their child to not access online resources must contact their respective building principal.
Responsible Use
Students are expected to use district technology equipment, software, and network services for projects assigned by their classroom teachers. The following are some guidelines concerning the use of district technology and network services.
Students may (with teacher supervision):
Students MAY NOT:
Note:
Other examples of inappropriate technology and network behavior will be considered on a case-by-case basis.
Students acting under the direction of the District Technology Coordinator or Building Technology Representatives may be exempt from some of the items listed.
Consequences of Irresponsible Use
Consequences for individuals violating the Responsible Use Policy vary depending on the nature and seriousness of the violation. Consequences might include disciplinary action, loss of technology access, and/or involvement of law enforcement agencies.
Warranties / Indemnification
Authorization for Use of Computer Resources within the [ - ] School District
As a user of the [ - ] Schools computer network, I hereby agree to comply with the above stated rules, communicating over the network in a reliable fashion while honoring all relevant laws and restrictions.
Student Name (Print):______________________________________
Password (Print):_________________________
Student Signature:___________________________ Grade:_______ Birthdate:_______
As the parent or legal guardian of the minor student signing above:
Parent Name (Print):______________________________________
Parent Signature:______________________________________ Date:_____________
Mailing Address:______________________________________
City:____________________________________
Home Telephone: _________________________