NAU CLINE LIBRARY
REQUEST FOR  LAPTOP COMPUTER REGISTRATION OF A MINOR
PARENTAL AUTHORIZATION FORM

To:
Circulation Supervisor, Access Services
NAU Cline Library
PO Box 6022
Flagstaff, AZ  86011

I am requesting that  my son/daughter ______________________________________ be registered to use their laptop computer to access the NAU network  in the Cline Library. I understand that  the access I am authorizing is to the NAU computer network and it includes full Internet access. Unless I notify the Circulation Supervisor of a change, my authorization is for one year.

I will assume full responsibility for the use of the NAU network by my son/daughter. My son/daughter and I will also read and sign the Cline Library Laptop Computer Acceptable Use Form.   

_________________________________________________________________________________
    Parent/Guardian (Please Print)

Address: __________________________________________________________________________

City: _______________________   State: ______________   Zip: _____________________________

Phone: ____________________________________________________________________________

SSN: __________________________   Parent/Guardian Card No: _____________________________

___________________________________________________________________________________
         Parent/Guardian Signature                                      Date

Please fill in the information below regarding the person to receive the laptop computer network access:

Name: ____________________________________________________________________________          
               Last                              First                              M.I.         

SSN: _______________________________________________________________________________