DUCHESNE COUNTY SCHOOL DISTRICT STUDENT ACCOUNT APPLICATION AND CONSENT FORM FOR EDUCATION INTERNET ACCESS
STUDENT SECTION Student Name ___________________________________________________ Grade _______________ (Last) (First) (Middle) School _________________________________________________________ I have read the Duchesne County School District Acceptable Use Policy and Student Guidelines, and agree to abide by their provisions. I understand that violation of the use provisions stated in the policy may constitute suspension or revocation of network privileges and may result in further disciplinary action, if and when my use of the district network is not consistent with educational usage.
Student Signature _________________________________________________ Date ________________
SPONSORING PARENT or GUARDIAN (Required) As the parent or legal guardian of this student, I have read the Duchesne County School District Acceptable Use Policy, related to the use of the Utah Link and the World Wide Network (Internet) and understand its contents. I understand that it is impossible for Duchesne County School District to restrict access to all controversial materials and I will not hold the District responsible for controversial materials my child acquires from the use of the Network. I agree to accept full responsibility for supervision if and when my child’s use of electronic resources is not in an educational setting. I hereby give my permission to issue an account for my child and certify that the information contained on this form is correct.
Parent/Guardian Signature __________________________________________ Date ________________
Home Address ___________________________________________________ Phone _______________ (Street) (City) (Zip)
*Student application must be renewed each academic year by the sponsoring school. School Approval by: _____________________________________________________________________________________ (Name) (Title) (Date)
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