SAMPLE
XYZ Charter
719
361/555-1234
Student Electronic
Communication Agreement
The Student Electronic
Communication Agreement must be renewed each academic year.
NAME_______________________________________________________GRADE______________ I understand that
my computer use is not private and that the XYZ Charter will monitor my
activity on the computer system.
I have read the XYZ Charter's electronic communications
system policy and administrative regulations and agree to abide by their
provisions. I understand that violation of these provisions may result in
suspension or revocation of system access.
Student signature_________________________________________
Date_______________________
PARENT
______I do not give
permission for my child to participate in the XYZ Charter's electronic
communications system.
I have read the XYZ Charter's electronic communications
system policy and administrative regulations. In consideration for the
privilege of my child using the XYZ Charter's electronic communications system,
and in consideration for having access to the public networks, I hereby release
the XYZ Charter, its operators, and any institutions with which they are affiliated
from any and all claims and damages of any nature arising from my child's use
of, or inability to use, the system, including, without limitation, the type of
damage identified in the XYZ Charter's policy and administrative regulations.
_______I give permission for my child to participate in the
XYZ Charter's electronic communications system and certify that the information
contained on this form is correct.
Signature of
Parent__________________________________________Date_____________________
Home Address______________________________________________________________________
Home
Phone______________________________ Work
Phone_______________________________
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