Below is a sample policy user agreement:
Technology and Internet Acceptable Use Policy 2014-2015
Signature Page
Student User (must be signed by student)
I understand and will abide by the Technology and Internet Acceptable Use Policy. I further understand that any violation of the regulations is unethical and may constitute a criminal offense. Should I commit any violation, my access privileges may be revoked, disciplinary action, and/or appropriate legal action may be taken.
User’s Full Name: ____________________________
User Signature: ______________________________
Date: ______________________________________
PARENT or GUARDIAN Statement of Understanding
As the parent or guardian of this student, I have read and agree to the Technology and Internet Acceptable Use Policy. I understand that this access is designed for educational purposes. The School has taken precautions to eliminate inappropriate material. However, I also recognize it is impossible for the School to restrict access to all inappropriate materials and I will not hold them responsible for materials acquired on the Internet. Further, I accept full responsibility for supervision if and when my child’s use is not in a school setting. I hereby give permission to issue an account for my child and certify that the information contained on this form is correct.
Student (please print): _________________________Grade: ______
Parent’s or Guardian’s Name (please print): _____________________________________
Parent’s of Guardian’s Signature: _____________________________________________
MEDIA RELEASE (Please check as appropriate)
I hereby give permission______ I hereby do not give permission _____
for _________________________to allow publication of my child’s image and creative efforts on the internet
and in promotional printed materials. Publication of pictures of my child and their creative works
could include stories, artwork, digital media creations, video recordings and interviews. I understand
that my child’s picture and/or creative works may appear in various media including but not
limited to newspapers, radio, television, the school yearbook and newsletters, print advertisements,
promotional videos, brochures, the school website, and other education marketing venues.
Parents or Guardian’s Name (please print): ___________________________________________
Parent or Guardian’s Signature: ____________________________________________________
Date: ________________________
Below is the link to an example of what the Geneva County Board of Education, as well as what another schools uses in regards to the Technology Usage Policy.
http://www.walsingham.org/document.doc?id=5517