KEC Gr 9 Application Form - Retsd.mb.ca

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Computer Use PermissionParent Permission SectionAs a parent or legal guardian of the minor student signing below, I give permission for myson/daughter to have access to:World Wide Web (Filtered Internet Access) Yes No Yes No Individual email(Filtered access and for students in grades 3 to 12 only)Please note:Parents who indicate “no” on any of the above points need to discuss this decision withtheir son/daughter.Parental Responsibility:I understand that any violation of use policies could result in loss of access, personalpayment of costs incurred and possible prosecution.Please Initial:I understand that the use of the Internet as part of an educational program is a privilege,not a right, and inappropriate use will result in cancellations of those privileges.Please Initial:___________________Student Name___________________________________ ________________________ _____________Parent NameParent Signature or StudentDateSignature if 18 years of ageor older.___________________ ________________________ _____________School Name Homeroom Teacher/Advisor GradeStudent Responsibility and Commitment (Students in Grades 3 to 12, please sign.)As a user of the River East Transcona School Division computer network, I hereby agree to comply with thedivisional computer technology use policy, communicating over the network in a responsible fashion whilehonouring all relevant laws and restrictions.Student NameStudent SignatureThis form will be applicable until the student enters Grade 3, transfers to anotherschool, or parents indicate a change in permissions.Effective Date: June 1, 2004 PolicyAmended Date:June 20, 2006; June 17, 2008March 15, 2011RegulationBoard Motion(s): 372/04; 326/04; 221/08; 70/11 Exhibit XXXLegal/Cross Reference:Exhibit IJND-E1 – Computer Use Permission Form Kindergarten to Grade 12 Page 3 of 3
CONSENT FOR EXCHANGE OF INFORMATIONI,(Parent/Guardian’s name)(Address)give consent for the River East Transcona School Division to receive and/or give information about(Postal Code)(Child’s full name)(Child’s birth date)Information may concern this child’s speech, language, intellectual, emotional and social developmentand educational, psychiatric, hearing or health needs.Information may be exchanged in written or spoken form.This Information may be received from and/or given to:(Name/Agency)(Address)(Postal Code)The Information will be used for(Purpose)Information received by the division will be kept in a confidential file and be seen only by those people working onbehalf of this child.It is my choice to give consent. I understand that I may withdraw this consent at any time by notifying the divisionin writing.Signature of parent/guardianDateWitnessDateTelephone Consent: This consent form was discussed with the parent/guardian who verbally consented toexchange of information.Name: (please print)Signature:Date:gc Jan29.09[Forms]Document No.
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KEC Gr 9 Application Form - Retsd.mb.ca

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