ELECTRONIC COMMUNICATION AND DATA MANAGEMENT
PETROLIA INDEPENDENT SCHOOL DISTRICT

STUDENT AGREEMENT FOR PARTICIPATION IN AN ELECTRONIC
COMMUNICATION SYSTEM

I.                     STUDENT

                 Name ________________________________      Grade __________________
                                         (Please Print)      

I have read the Petrolia ISD “Electronic Communications & Data Management Policy” and agree to abide by their provisions.  I understand that violation of these provisions may result in suspension or revocation of system access.

Student’s Signature   ____________________      Date ________________________

II.                   STUDENT’S PARENT OR GUARDIAN

I have read the Petrolia ISD electronic communications system policy and administrative regulations.  In consideration for the privilege of using the Petrolia ISD electronic communications system, and in consideration for having access to the public networks, I hereby release the District, 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 Petrolia ISD policy and administrative regulations.

A. ____ I give permission for  my child to participate in ALL areas of the District’s electronic
              communication system and certify that the information contained on this form is correct.

                                                OR

B. ____I DO NOT give permission for my child to participate in the District’s electronic communication
             system.

                                                OR

C. ____I give LIMITED permission for my child to participate in the District’s electronic communication
             system and certify that the information contained on this form is correct.

 (Please indicate whether or not you give permission for each section by writing yes or no on the line before each section.)

____My child may participate in doing research and communication activities on the Internet.

____My child may participate in interactive lessons on the Internet.

____My child’s written or artistic work may be published on the school’s web site.

____My child’s picture may be published on the school’s web site.

____My child’s name may be published on the school’s web site.

____I give my permission for my child’s image to be streamed and rebroadcast.

Signature of Parent or Guardian: _________________________________________________________

Home Address: _______________________________________________________________________

Phone Number: _______________________________________________________________________

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