NEPN/NSBA Code: IJNDB–E MSAD #37 Student Internet Access Acknowledgment Form No student shall be allowed to use the Internet until the student and parent/guardian have signed and returned this acknowledgment to the school. Student: I have read policy IJNDB — Student Computer and Internet Use and policy IJNDB–R — Student Computer and Internet Use Rules and agree to comply with them. _______________________________________ Signature of Student

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Parent/Guardian: I have read policy IJNDB — Student Computer and Internet Use and policy IJNDB–R — Student Computer and Internet Use Rules and understand that my son/daughter’s use of the Internet is subject to compliance with these rules. _______________________________________ Signature of Parent/Guardian

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Form approved: September 27, 2000 MSAD #37 Board of Directors