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2022-23 Grade 7-12 Technology / Media Signature Page
Please read/review the Acceptable Use Policy and Device Agreement (links below) with your student, then complete the form below as your electronic signature. Complete one form for each student. Grades 7-12 are responsible for a $35 yearly technology fee, which may be paid at time of pickup, mailed to the office, or paid online via the K-12 payment center (www.
k12paymentcenter.com
). You may need to set up an account. Please login to see your fee balance. Forms and payment must be received in order to pickup laptop.
If you have questions, please contact Lu Larsen at 218-945-6953 or
tech@isd599.org
Link for Grades 7-12 Agreement - -
http://www.fertilebeltrami.k12.mn.us/Website/pages/Tech%20Forms/22-23UC.pdf
Link for District Policy Handbook Item # 524 - Internet Acceptable Use Policy
http://www.fertilebeltrami.k12.mn.us/Website/pages/Tech%20Forms/Article524.pdf
* * * New for year 2022-23 School year * * *
Included on this form is the Acceptance for Media Release for your student. Please read the Media Release Acceptance statement here - -
https://docs.google.com/document/d/1fRpTUFV_KDV2Mhq_OPW_BCmbzU4rzgtEL84mviDjqek/edit?usp=sharing
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* Required
Student Name
*
Your answer
Student Grade
*
Choose
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Student Address and Phone #
*
Your answer
Parent Name
*
Your answer
Parent address and Phone #
*
Your answer
Check the following.. By signing, I understand that:
*
Sleeves will be provided for the student to transport the device in their backpack from school to home.
Parent/Guardian/Student are financially responsible for any damages incurred to the device.
Students are responsible for using the device in accordance with the district’s Internet Acceptable Use Policy.
Required
Student Signature
*
I have read and understand the Account Agreement and Acceptable Use Policy and agree to follow the rules contained in the policy.
Required
Parent Signature
*
I have read and understand the Account Agreement and Acceptable Use Policy. If internet is provided at home, I will supervise my child's use of the system in accordance with the acceptable use policy.
I hereby release the district, its personnel, and any institutions with which it is affiliated, from any and all claims and damages of any nature arising from my child’s use of, or inability to use, the district system, including, but not limited to claims that may arise from the unauthorized use of the system to purchase products or services.
I will instruct my child regarding any restrictions against accessing material that are in addition to the restrictions set forth in the District Acceptable Use Policy. I will emphasize to my child the importance of following the rules for personal safety.
I give permission to issue an account for my child and certify that the information contained in this form is correct.
Required
Media Release Acceptance.. Please indicate your choice:
*
My student's name and/or picture may be used in academic and/or sports highlights in media venues, including newspaper and school-related social media.
My student's name and/or picture may NOT be used in academic and/or sports highlights in media venues, including newspaper and school-related social media.
Other:
Date
*
MM
/
DD
/
YYYY
Device Number and Model (School will complete this section)
Your answer
Serial Number (School will complete this section)
Your answer
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