Video IJND-Parent Permission Form

 Fulton County Schools
Parent Permission Form
For Instructional Use of Video

Date: _______________________

Please indicate below whether or not you give permission for your child to view the video named on this form. Parental permission is required for students to view this video/audio because it has a Parental Guidance (PG), Parental Guidance 13 (PG13), or Restricted (R) rating. It will be used in this course as supplementary material.

Thank you,

Principal

************************************************************************
Teacher: ___________________________________________________________________

Course: ____________________________________________________________________

Title of Video: _________________________________________________________

Date to be Shown: ____________________________________

Instructional Rationale for Showing: ___________________________________________________

______________________________________________________________________

______________________________________________________________________

Rating:
_____Parental Guidance (PG)
_____Parental Guidance 13 (PG13 – middle school ONLY)
_____Restricted (R) (high school students ONLY)
_____Yes, ______________________________________,

has my permission to view the video.

_____No, ______________________________________,

does not have my permission to view the video.

___________________________________ __________________
Parent’s Signature Date

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