As the parent or legal guardian of the minor child named below, I have read, understand and accept the rules governing the use of the library's Internet connection. I understand that some sites on the Internet may be objectionable, but I accept responsibility and consent to my child age eleven to fifteen to use the Internet independently. I agree to accompany my child ten and under or allow my child to use the Internet with the adult who accompanies him/her to the library.

Child's Name______________________________________DOB_________

Parent's Name______________________________________________

Parent's Driver's License Number____________________________

Parent's Signature__________________________________________

Phone Number _____________________________________________

Date_______________________________________________________

Parents of eleven to fifteen year old children:

Please note that your signature on this permission slip gives your child your permission to use the library's Internet connection at any time in the future whether you accompany your child or not. Children age 11 to 15 without this permission agreement will not be allowed to use the Internet computers unless they are accompanied by an adult at the computer.