[Education Agency Name]
(To be signed by all adult users and student users above grade 5)
I have read, understand, and will abide by the above Acceptable Use Policy when using computer and other electronic resources owned, leased, or operated by the [Education Agency Name]. I further understand that any violation of the regulations above is unethical and may constitute a criminal offense. Should I commit any violation, my access privileges may be revoked, school disciplinary action may be taken, and/or appropriate legal action may be initiated.
User Name (please print)
User Signature Date
(To be signed by parents of all student users under the age of eighteen)
As parent or guardian of this student, I have read the Acceptable Use Policy. I understand that this access is designed for educational purposes. [Education Agency Name] has taken reasonable steps to control access to the Internet, but cannot guarantee that all controversial information will be inaccessible to student users. I agree that I will not hold the [Education Agency Name] responsible for materials acquired on the network. Further, I accept full responsibility for supervision if and when my child's use is not in a school setting. I hereby give permission for my child to use network resources, including the Internet, that are available through [Education Agency Name].
Parent Name (please print)
Parent Signature Date