Parent or Guardian (if applicant is a student):

I have read the Diocese of Charlotte Catholic Schools Acceptable Use Policy for Internet Usage. I understand that this access is designed for educational purposes. The Diocese of Charlotte has taken precautions to eliminate controversial material. However, I also recognize it is impossible for the Diocese of Charlotte to restrict access to all controversial materials and I will not hold them responsible for materials acquired on the network. Further, I will accept responsibility for supervision if and when my child’s use of the Internet is not in a school setting.

_____ I hereby give permission for my child to have access to the Internet at any Diocese of Charlotte School. I also certify that the information contained on this form is correct.

OR

_____ I DO NOT give my child permission to use the Internet or school e-mail accounts.

__________________________________________________________________________

I understand that from time-to-time the school may wish to publish examples of student projects, photographs of students, and other work on an Internet accessible World Wide Web server.

_____ My child’s work may be published on the Internet. (No last name will ever be included).

_____ Photographs of my child may be published (No last name will ever be included).

_____ No - my child’s work may not be published.

_____ No - my child’s photograph may not be published.

Parent or Guardian’s Name: ________________________________________ (please print)

Parent or Guardian’s Signature: ______________________________________

Date _____________________

Students’ Names Grade ________________________________________________________________

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