Device and Internet Use Agreement

Permission to use the school’s devices is dependent upon a student and his or her parent/guardian signing the form below.  Signing the form shows that the student understands and will follow the school’s device and internet rules.  Failure to follow the rules may result in a student being denied the opportunity to use the district’s devices.

I understand and I will abide by the above regulations and the regulations listed in the Laptop Handbook for Students and Parents (grades 4-12) or Device Care and Etiquette flyer (grades PK-3). I (the parent or guardian) acknowledge and agree to the responsibility I have to ensure my child uses their device, when it is at home, for school related educational purposes only. I (the student and parent) further understand that any violation of the regulations above described is unethical and may also constitute a criminal offense. Should I commit a violation, my access privileges may be revoked, the school district may commence disciplinary proceedings against me, and I may be subject to appropriate legal action by the school district or others. Should the device become damaged or lost, I understand that I am responsible for the appropriate charges for repair or replacement. Further, I will hold the Richfield Springs Central School District harmless against all damages, judgments, and attorneys fees that may be obtained against them arising out of my use of the Internet.

This statement will also acknowledge that we have read, reviewed, and understand the Responsible Use Policy for Network and Internet Access (RUP). We understand that the RUP is in effect whether the device is used at home or at school and applies to all technological devices owned by the district. 

Sign in to Google to save your progress. Learn more
Student Last Name *
Student First Name *
Grade Level *
I give permission for my child to participate in the Richfield Springs CSD 1 to 1 Device Program. I understand my potential financial obligation.  *
Choose one: 
PARENT ACKNOWLEDGEMENT
By typing my name below, I acknowledge that I have read this form and the linked documents in their entirety and agree to abide by the regulations set forth by Richfield Springs CSD.
*
Please type parents'/guardians' names below. This is your digital signature.
STUDENT ACKNOWLEDGEMENT
By typing my name below, I acknowledge that I have reviewed the linked documents with my parent/guardian and agree to abide by the regulations set forth by Richfield Springs CSD.
*
Please type student's name below. This is your digital signature.
No student will be issued a device until this form is completed.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Richfield Springs Central School. Report Abuse