Permission slip for LAN Assembly

I understand and will abide by the terms and conditions regarding the use of the Computer system. I further understand that any violation of the regulations is unethical and may constitute a criminal offense or violation of the “MGA rules and regulations.” Should I commit any violation, my access privileges may be revoked, school disciplinary and/or appropriate legal action may be taken.

NAME OF USER _______________________________ DATE ______________

HOME TELEPHONE _________________ DATE OF BIRTH ____/____/_____

SCHOOL _______________________________________ GRADE ___________

SIGNATURE ______________________________________________________

As the parent or guardian of ____________________________, I have read the Terms and Conditions and Acceptable Use Guidelines for the use of the computers and other hardware/software. I understand that this access is designed for educational purposes and that the Advisor will supervise its use as fully as possible.

I recognize that it is impossible for the teacher to restrict access to all controversial materials, and I will not hold him/her, the school or the school system responsible for materials acquired on the computers in violation of this policy statement.

Further, I accept full responsibility for supervision if and when my child’s use is not in the school setting. I hereby give my permission to issue computer access for my child and certify that the information contained on this form is correct.

PARENT PRINTED NAME ___________________________ DATE ___________

PARENT SIGNATURE ___________________________ DAY PHONE _________