NOTE: One copy must be submitted for each child in your household.
Check One
 YES
 NO
Parent Consent Checklist
Directory Information: I give the district permission to: (check all that apply)
 Use identified personal information for the specified school-sponsored purposes, such as directory
information.
 Release identified personal information in response to a request unrelated to school-sponsored purposes.
(See Directory Information in Section IV for more information.)
 YES
 NO
Release of Student Information: I give the district permission to release my child’s name, address, and telephone
number to a military recruiter or institutions of higher education upon their request without my prior written consent. (See
Release of Student Information to Military Recruiters and Institutions of Higher Education in Section IV for more
information.)
 YES
 NO
Consent/Opt-Out: I give my child permission to participate in school activities such as student surveys, analysis, or
evaluation, known as “protected information surveys”. (See Obtaining Information and Protecting Student Rights in
Section IV for more information regarding the referenced surveys.)
 FA
(Full Access)
 CO
(Computer Only)
Student Acceptable Use Policy: I give my child permission to use the district’s computers, electronic communications
system/Internet access, and district approved web communication tools. I have read and understand the Student
Acceptable Use Policy. I have also discussed the rules and consequences with my child as well as consent to the
monitoring of my child’s district e-mail account. Note: This AUP signature will remain in effect for a full calendar year from
the date of the student’s/parent’s signature. (See Computer Use – Student Acceptable Use Policy [AUP] in Section IV
for more information.)
In the event that CO (Computer Only) is selected as your choice, please be advised that your child will be assigned a
network login and that your child may be required to use computers for purposes such as word processing, use of
educational resources, Texas Education Agency adopted online materials, taking mandated online tests and mastering
technology objectives outlined by the Texas Education Agency.
 YES
 NO
Internet Release: I give the district permission to use the following items on the Fort Bend ISD Web site, my child’s
campus Web site, or district publications as well as in-house campus video presentations: (check all that apply)



My child's first name (Note: Last names will not be used.)
My child's photograph
My child's individual or team academic work, creative work, extracurricular accomplishments, multimedia
project, or presentation. (Note: Grades associated with student work will not be displayed.)
(See Internet Release of Student Information in Section IV for more information.)
 YES
 NO
 YES
 NO
Photograph/Video/Audio Record Release: I give the district permission to photograph or video/audio record my child for
any of the purposes stated in the FBISD Student/Parent Handbook. (See Granting Permission to Video or Audio
Record A Student in Section IV for more information.)
Receipt of 2010-2011 FBISD Extracurricular Activities Information: I understand and consent to the student
responsibilities set forth in the FBISD Extracurricular Activities Information section of the handbook. I acknowledge
that my child shall be held accountable for the behavior expectations and consequences set forth in the FBISD
Extracurricular Activities Information. (See Extracurricular Activities Information in Section III for more information.
(Note: Applies to Grades 6 – 12 only.)
Student Consent Checklist
Student Acceptable Use Policy: I have read and understand the Student Acceptable Use Policy as it applies to my use of computers and
electronic communication networks in FBISD. I agree to abide by all rules for acceptable use and consent to the monitoring of my district e-mail
account. I understand there may be consequences for violating the rules stated in the Acceptable Use Policy (AUP), including termination of
my privileges.
2010-2011 FBISD Extracurricular Information: This is to acknowledge that a copy of the 2010-2011 FBISD Extracurricular Activities
Information is available on line or in print upon my request. I have read and understand the information contained in the handbook.
Student AUP
Extracurricular
Student’s Printed Name & Signature
 YES
 YES
Printed Name:_________________________________________ID#:__________________
Signature: _________________________________________________________________
Parent/Guardian’s Signature: _______________________________________________ Date: ___________________