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Fees owed-------------------------------------- ___________

Total ___________

Thanks!

Use of Internet

Return to District —this signed agreement         HB# ___________

Parents------For students:   _____________, ____________, ___________, ___________

Student Name             Grade[circle one for each student]

_____________________________     Unlimited AccessRestricted Access

_____________________________     Unlimited AccessRestricted Access

_____________________________     Unlimited AccessRestricted Access

_____________________________     Unlimited AccessRestricted Access

_____________________________     Unlimited AccessRestricted Access

_____________________________     Unlimited AccessRestricted Access

For Students:

I understand and will abide by the INTERNET USE AGREEMENT.  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 will be removed as stipulated, and if necessary, disciplinary and /or appropriate legal action may be taken.

PARENT or GUARDIAN

I have read the INTERNET USE AGREEMENT.  I understand that this access is designed for educational purposes.  The Seymour Community School District has taken precautions to eliminate controversial material by the use of administrative regulations and automatic block out systems.  However, I recognize it is impossible to restrict access to all controversial materials and I will not hold the district responsible for materials acquired on the network.  Further, I accept full responsibility for supervision if and when student use is not in the school setting.  I hereby give each of my children permission for the use of the INTERNET as identified above.  

UNLIMITED ACCESS or RESTRICTED ACCESS as noted above to the INTERNET------ (Also See " Internet Privileges" SHS Student handbook).

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