TECHNOLOGY USER AGREEMENT and PARENT PERMISSION FORM
As a parent/guardian and student of Incarnate Word Academy, we have read the information on
the appropriate use of technology at school and the appropriate use of electronic communication,
and we understand this agreement will be kept on file for the 2021-2022 school year.
Whether occurring within or outside of school, when a student’s use of electronic communication
jeopardizes the safe environment of the school or is contrary to Gospel values, the student can
be subject to the full range of disciplinary consequences including expulsion.
This policy applies to communications or depictions through e-mail, text messages, blogs,
twitters, or web site postings, whether they occur through the school’s equipment or connectivity
resources or through private communication.
This form may be signed in counterparts and may be delivered by facsimile or other electronic
means, each of which may be deemed an original, and all of which together constitute one and
the same agreement.
Print Student Name
Grade
Date
Student Signature - First, Middle, and Last Name
Parent Signature - First, Middle, and Last Name
Media Release Form 2021 -2022
Incarnate Word Academy and its affiliates often use photographs and video images of students,
faculty and staff in publications, media, public relations, fundraising and recruiting material.
(Initial one ONLY):
We consent and give permission to Incarnate Word Academy and its affiliates to
use photographs/and or video images of our daughter in publications, media,
public relations, fundraising and recruiting material.
OR
We do NOT want our daughter’s image to be used in publications or any other
media.
Parental Rights Information 2021-2022
Incarnate Word Academy conforms to the appropriate court orders governing rights and
duties of parents in regard to their child(ren). Divorced and/or separated parents are required
to file with Incarnate Word Academy certified copies of the most recent court orders together
with all amendments, modifications and supplements. Parents are to ensure that Incarnate
Word Academy has a complete and unaltered set of certified copies of the applicable court
orders.
(Initial one ONLY):
IWA 2021-2022
No - There are no court orders on file governing parental rights and duties.
Yes - There are court orders on file governing parental rights and duties. I will
provide Incarnate Word Academy certified copies of the most recent court
orders together with all amendments, modifications, and supplements.
OR
