"Permission to View Film/Video Template"

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School Name:
School District:
Permission to View Film/Video
Dear Families,
Occasionally, film/videos are used in the classroom in order to illustrate a particular
curricular-related concept.
I am notifying you that we will be watching a film/video in class with a rating above the G
rating.
I will be showing a film/video in the classroom on ___________________.
Film/Video Title: ____________________________________________________________
Motion Picture Industry Rating: _______________
Topic under discussion to which movie is relevant: _________________________________
_________________________________________________________________________
_________________________________________________________________________
Instructional objectives: _____________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Please return the permission slip below by _______________________.
Teacher's Signature ________________________________ Class ____________________
-------------------------------------------------------------------------------------------------------
Child’s Name ______________________________________________________________
____ Yes, I give my son/daughter permission to view curriculum and school appropriate
film/videos related to classroom content and subjects.
____ No, I do not give my son/daughter permission to view curriculum and school
appropriate film/videos mentioned in this letter. I understand alternate learning experiences
will be provided for my child while the movie is being watched.
Signature of Parent or Guardian: ______________________________________________
Date: _______________________________________
School Name:
School District:
Permission to View Film/Video
Dear Families,
Occasionally, film/videos are used in the classroom in order to illustrate a particular
curricular-related concept.
I am notifying you that we will be watching a film/video in class with a rating above the G
rating.
I will be showing a film/video in the classroom on ___________________.
Film/Video Title: ____________________________________________________________
Motion Picture Industry Rating: _______________
Topic under discussion to which movie is relevant: _________________________________
_________________________________________________________________________
_________________________________________________________________________
Instructional objectives: _____________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Please return the permission slip below by _______________________.
Teacher's Signature ________________________________ Class ____________________
-------------------------------------------------------------------------------------------------------
Child’s Name ______________________________________________________________
____ Yes, I give my son/daughter permission to view curriculum and school appropriate
film/videos related to classroom content and subjects.
____ No, I do not give my son/daughter permission to view curriculum and school
appropriate film/videos mentioned in this letter. I understand alternate learning experiences
will be provided for my child while the movie is being watched.
Signature of Parent or Guardian: ______________________________________________
Date: _______________________________________
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