DUCHESNE COUNTY SCHOOL DISTRICT STUDENT ACCOUNT APPLICATION AND CONSENT FORM FOR ELEMENTARY STUDENTS
STUDENT SECTION Student Name ___________________________________________________ Grade _______________ (Last) (First) (Middle) School _________________________________________________________ I have read the Duchesne County School District Elementary 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 and school privileges and may result in further disciplinary action, (which could include appropriate legal 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 Elementary Student Acceptable Use Policy I understand that student access is designed for educational purposes. I recognize that it is impossible for Duchesne County School District or the Utah Education Network to restrict access to all controversial materials, and I will not hold the district or staff responsible for materials acquired on the Internet. Further, I accept full responsibility if and when my child is found in violation of this computer use policy.
Parent/Guardian Signature __________________________________________ Date ________________
Home Address ___________________________________________________ Phone _______________ (Street) (City) (Zip)
*Student application must be renewed each academic year by the sponsoring school.
Revised September 20, 2010
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