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San Lorenzo Valley USD |  E  6163.4  Instruction

Student Use Of Technology   

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Student Name:______________________________________________________________

Please Print

I understand that the district may provide me access to the district's technological resources for educational purposes, and that this access is a privilege, not a right. I acknowledge that I have been provided, read, and understand policies and regulations regarding the use of district's technological resources. I further acknowledge that inappropriate use of the district's technological resources shall result in a cancellation of my student user privileges, disciplinary action, and/or legal action, in accordance with law, Board Policy, and Administrative Regulations.

I have read, understand, and will abide by Board Policy and Administrative Regulation 6163.4 regarding Student use of Technology.

(Board Policy 6164.3, Administrative Regulation 6164.3, and the Student Use of Technology Agreement can be found at

Student Signature____________________________________________________________

(for grades 4 - 12)

Date:_______________________ School Site: ____________________________________

Parent/Guardian Signature:_____________________________________________________

Date: ________________

Permission for Internet Use:

__ I hereby give permission for my child to use the Internet. I understand that this permission includes permission for my child to access information through the Web, receive e-mail communications through a class account, and engage in other educationally relevant electronic communication activities, and provide personal information to others for education or career development reasons or as approved by school staff.

__ I do NOT give permission for my child to use the Internet EXCEPT when supervised as a part of regular classroom instruction.

Parent/Guardian Signature:____________________________________________________

Date: ________________


version: July 7, 2010 Ben Lomond, California

revised: August 23, 2016