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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 for "First Name"

Middle Initial

Answer required for "Middle Initial"

Last Name*

Answer required for "Last Name"

Today's Date*

Answer required for "Today's Date"

Email Address*

Answer required for "Email Address"

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

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 for "Additional Comments/Questions"