Chester County School

Student Access Release and Authorization Form

As a user of the Chester County Schools computer network, I hereby agree to comply with the Acceptable Use Policy (AUP) Agreement.  Should I commit any violation, my access privileges may be revoked, and disciplinary action may be taken up to and including suspension/expulsion.

Student Signature:  ______________________________

As the parent or legal guardian of the student signing above, I grant permission for him/her to access networked computer services such as electronic mail and the Internet, I understand that he/she is expected to use good judgment and follow rules and guidelines in making contact on the telecommunication networks (e.g. the Internet).  Chester County Schools cannot be responsible for ideas and concepts that he/she may gain by his/her use of the Internet.

I understand and accept the conditions stated and agree to hold harmless, and release from liability, the school and school district.

Parent/Guardian Signature  _________________________ Date _____________

Student Name __________________________  Grade Level ___________

School _________________________

Home Address and Zip Code

Home Phone ____________________  Work Phone  _______________