BEAUCLERC ELEMENTARY STUDENT COMPUTER AND INTERNET USE AND SAFETY PARENTAL PERMISSION FORM

 

Student Section                                                                       

I have read the Code of Student Conduct and the section on Guidelines for the Safe and Acceptable Use of

Computers and the Internet. I agree to follow the rules contained in this document. I understand that if I

violate the rules, my account can be terminated, my access to computers suspended, and I may face other

disciplinary measures.

Teacher Name: ­­­­­­­­­­­­­­­­­­­­_________________

 

Student Signature__________________________________________________ Date______________

 

Student Name (Print) ______________________________________________ Date______________

 

Parent/Guardian Section

Internet Permission

I have read the Code of Student Conduct and the section on Guidelines for Safe and Acceptable Use of Computers

and the Internet. I hereby release the Duval County Public Schools, its personnel, and any institution with which

it is affiliated, from any and all claims and damages of any nature arising from my child’s use of, or inability to

use, the DCPS computer system, including, but not limited to, claims that may arise from the unauthorized use of

the system to purchase products or services. I will emphasize to my child the importance of not sharing personal

information via the Internet or passwords.

 

* Please check one:

_____ I give permission for my child to use the Internet.

 

_____ I do not give permission for my child to use the Internet

 

NOTE: Some instructional software programs require Internet access to function properly. Alternative

instructional materials can be provided to a student not granted parent/guardian permission to use the

Internet.

 

Digital Communication Consent

Duval County Public Schools publish a variety of information about our schools and district on a portion of the

Internet known as the World Wide Web. From time to time we may wish to include your child’s work (stories,

poems, reports) and/or photo on our web site. No last names are used under elementary student work. Last

names may be used under secondary student work. No names will be placed under photos. Student photos will

be only used generically. No identifying marks or physical characteristics, clothing, or other articles bearing a

student’s name or any other means by which a student can be identified will be photographed. No other personal

information about the student, such as e-mail address, phone number, or home address will be published on the

Web. Schools also videotape and will occasionally use portions of video on in-school television programs.

 

*Please check one:

 

_____ I consent to our child’s work, photo, or name being used in any digital communication form as described

above.

 

_____ I do not give consent to our child’s work, photo, or name being used in any digital communication form

as described above.

 

Parent/Guardian Signature_______________________________ Date_______________

 

Parent/Guardian Name (Print) ____________________________ Date_______________

 

(SIGNED CONSENT AND WAIVER DOCUMENTS WILL BE KEPT ON FILE AT EACH RESPECTIVE SCHOOL SITE AND UPDATED YEARLY.)

Note: Failure to return this acknowledgement form will not relieve a student or the parent/guardian of the student from responsibility for

knowledge or non-compliance of the contents of the Code of Student Conduct, Bus Behavior Agreement, and Internet Use Policy.