2012 KIDS & TEEN COLLEGE REGISTRATION FORM PAGE 4 REGISTRATION INFORMATION - Continued INTERNET ACCESS CONSENT AND WAIVER FORM The following form must be read and signed by the participating student and your parent or legal guardian
Student: By signing this Consent and Waiver form, I ____________________________________ (print name) and my parent(s) or guardian(s) agree to abide by the restrictions stated below. I have discussed these rights and responsibilities with my parent(s) or guardian(s). Parent(s) or Guardian(s): I have been advised that The Pennsylvania State University (the “University”) does not have control of the information available through the Internet or other electronic data sources. Sites accessible via the Internet or other electronic data sources may contain material that is illegal, defamatory, inaccurate, obscene, profane, sexually explicit, or potentially offensive to others. While the University’s intent is to make Internet access available to further the educational goals and objectives of its summer programs, students will, without sanction of the University, have the ability to access materials that are not part of the program curriculum. The student and his or her parent(s) or guardian(s) must understand that student access to the University’s network supports the University’s educational responsibilities and mission. The University makes no warranties with respect to the University’s network service, and it specifically assumes no responsibilities for:
A. The content of any advice or information received by a student from a source outside the University, or any costs or charges incurred as a result of seeing or accepting such advice.
B. Any costs, liability or damages caused by the way the student chooses to use the University’s network. C. Any consequences of network service interruptions or changes.
By signing this Consent and Waiver form, I (student) agree to the following terms:
A. My use of the University’s network must at all times be consistent with the University’s “Computer and Network Security” policy, a copy of which is available at http://guru.psu.edu/policies/AD20.html
B. I will not use the University’s network for illegal purposes of any kind. C. I will not use the University’s network to transmit threatening, obscene, or harassing materials. The University will not be held responsible in any way if I participate in such activities.
D. I will not use the University’s network to interfere with or disrupt network users, services or equipment. Disruptions include but are not limited to distribution of unsolicited advertising, propagation of computer worms and viruses, and using the network to make unauthorized entry to any other machine accessible via the network.
E. I understand that the use of the University’s network is a privilege and not a right, and that inappropriate use of the University’s network will result in the immediate cancellation of my privilege to use it.
______________________________________ ___ _________________________________________ Student Signature
_________________________________________ _________________________________________ Parent/Guardian Signature
Date All forms must be completed and signed in order for your registration to be complete.
Registrations may be mailed or delivered in person to: Penn State Abington Continuing Education Cloverly Building 1600 Woodland Road Abington, PA 19001
Fax Registrations to: 215-881-7412 Scan & Email Registrations to: firstname.lastname@example.org
Online Registration and Information: www.abington.psu.edu/youthteen
Refunds: If you must cancel or withdraw from a program, please notify our office in writing (mail, email or fax) 3 days prior to the first day of class. All withdrawals are subject to a $35 processing fee per program per student. No refunds will be given after the program begins. Cancellations: The University may cancel any course because of insufficient enrollment or other unforeseen circumstances.
If this occurs, students will be notified by phone and no processing fee will be assessed. Page 4 of 4 215-881-7400 21
| Page 2
| Page 3
| Page 4
| Page 5
| Page 6
| Page 7
| Page 8
| Page 9
| Page 10
| Page 11
| Page 12
| Page 13
| Page 14
| Page 15
| Page 16
| Page 17
| Page 18
| Page 19
| Page 20
| Page 21