Parental Permission to View PG or PG-13 Video/DVD

Policy Code: 
IGDC-E1
Adoption Date: 
Tuesday, January 27th, 2009

Parental Permission to View PG or PG-13 Video/DVD


Teacher _________________________Subject ________________ Grade Level  ________       

 

The following video/DVD will be used in class on (date) ___________________             


 ________video/DVD shown in its entirety                   _____appropriate clip previewed

                                                                                                     by the teacher named on this form

 

Title  _______________________________________________________

Rating ___________________

 

 

Causes of Rating:

 

 

 

Relationship between video/DVD content and the curriculum:

 

 

 

 

 

Alternative activity for those not viewing the video/DVD

 

______I give permission for (student) ______________________________________________ to view the video.

 

 

Parent/Guardian Signature ______________________________________________________ Date _____________

 

______Rather than viewing the video, I would like my son/daughter to participate in the alternative activity.

 

 

Parent/Guardian Signature ______________________________________________________ Date ______________