I, the parent/legal guardian, give _____________________________________­permission    Name of minor

to use the RPL computer system, including the Internet, in my absence.

I will not hold RPL responsible for monitoring the child’s actions on the computer/Internet.

I, as parent/guardian, am responsible and will guide said child in the allowable usage of the system.

The child will abide by RPL’s Computer Usage Guidelines.

 

Signed___________________________________________________Date______________

Address____________________________________________________________________

City__________________________________________State__________Zip_____________

Home Phone ________________________________ Alternate Phone__________________

Child’s Birth Date________________________