Name : ________________________________

 

Grade: ________________________________

 

E-Mail: ________________________________

 

Phone: ________________________________

 

Why Do You Want to Have a Home Page?

 

 

 

What Would You Want to Put on Your Home Page?

 

 

 

 

Referred By: _________________________________
 

Parent Signature ______________________________

Parent Comments: (to be used for specific restrictions you would like on your childs account)

 

 

 

 

Please print this form and send an email to studentweb@washington.k12.ia.us for instructions on who to give your form to. We will then activate your account as soon as possible.