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"Many a man wishes he were strong enough to tear a telephone book in half-especially if he has a teenage daughter."

—Guy Albert Lombardo (1902-77) Canadian-born American bandleader

 

Internet Access Parental Consent Form

Parental Consent Form

By signing below, I assume responsibility for my child's actions and acknowledge that restriction of my child's access to the Internet is solely my responsibility as his/her parent/guardian.

I have read the Rules for the Use of Public Computers and have instructed my child in the rules governing the Library’s Internet access. I realize that not every site on the Internet may be desirable for underage individuals. I understand these rules and the Library’s position and agree to abide by the guidelines and policies.



I give my permission for my child to use the Internet station unattended. YES ______

Parent or Guardian’s Signature

__________________________________________________

Please print name of parent below and name of child covered in this consent form (Please use a separate form for each child using the Internet.):

Parent:__________________________________________________________________

Child's Name: _______________________________________

School Grade: _______________________________________

Date: ________________

Child's Library Bar Code Number (if available)

_________________________________________________

Address__________________________________________

Phone______________________



Approved by the Roxana Public Library District Board of Trustees; revised November, 1999; February , 2006.

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Location and Hours

LOCATION

200 North Central Avenue

Roxana, IL 62084

618-254-6713

 

HOURS

Monday-Thursday

10-8

Friday-Saturday

10-5

Closed Sunday

 

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