Last Name:____________________________________________________

First Name:____________________________________________________

Expected Year of Graduation for 8th Grade:____________

Student Contract Agreement Application Form -- Internet Account

Directions:  After reading the application for Account and Terms and Conditions, please read and fill out the following contract completely and legible.  The signature of a parent or guardian is also required.  Please return the contract to the school office.

Contract Portion of Document

I have read the Terms and Conditions.  I understand and will abide by the stated Terms and Conditions for Internet Usage.  I further understand that violation of the regulations is unethical and may constitute a criminal offense.  Should I commit any violation my access privileges may be revoked for the rest of the semester and/or year school disciplinary action may be taken and/or appropriate legal action.

User Name (please print):____________________________________________

User Signature:_____________________________________________________

Date:_____________________________

Parent or Guardian

As the parent or guardian of this student.  I have read the Terms and Conditions for Internet usage.  I understand that this access is designed for educational purposes and material.  However, I also recognize it is impossible for New York School to restrict access to all controversial materials and I will not hold them responsible for materials acquired on the network.  Further, I accept full responsibility for supervision if an when my child's use is not in a school setting.  I hereby give my permission to issue an account for my child and certify that the information contained on this form is correct.

Parent or Guardian (please print):___________________________________________________

Signature:_____________________________________________        Date:__________________