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Staff - Internet Use Policy Acceptance Form

Please complete the form below. Required fields marked with an asterisk *

First Name*

Answer Required

Middle Initial

Answer Required

Last Name*

Answer Required

Today's Date*

Answer Required

Email Address*

Answer Required

I give the School the following permission in the following (please verify all that apply)*

IF YOU DO NOT WANT ANY/ALL AVAILABLE OPTIONS BELOW, PLEASE LEAVE ANY/ALL UNCHECKED (Note: under no circumstances will your home address or phone number be published on the Internet.)

Answer Required

Publication on the Web of my creative efforts, including stories and artwork.

Use of my name in School Web Publications.

Use of my picture in School Web Publications.

Additional Comments/Questions

Answer Required