Form: Internet Use Agreement

__________ Public Library


I understand and will abide by the __________ Public Library's Internet Use Policy. I further understand that any violation of the regulations is unethical and may constitute a criminal offense. Should I commit any violation, my access privileges will be revoked and appropriate legal action may be taken.

User's Name: ___________________________________

User's Signature: ________________________________

Date: _____________________________

As the parent or guardian of this individual, I accept full responsibility for my child's use of the __________ Public Library's Internet service and agree to oversee my child's use of this service. I have read the attached Internet Use Policy, and I understand that the library's access to the Internet is intended and designed for eduactional and informational purposes. I will not hold the library responsible for materials or information acquired by my child through the use of the library's Internet service. I hereby give permission for my child to use the library's network for Internet access and certify that the information contained on this form is correct.

Parent's/Guardian's Name: ____________________________

Parent's/Guardian's Signature: _________________________

Date: ____________________________