Annual Movie Permission Slip

(Last Updated On: September 10, 2014)

Annual Movie/Video Permission

Dear Parents,

During the course of the _________________ school year we plan to show PG/PG-13/R rated movies in full or as excerpts to enhance our class curriculum.
(circle all that apply)

Our school requires parental permission for your student to view movies that are used in our curriculum, or selected by our teachers, which are rated PG-13 or R.

We believe showing your son or daughter movies such as Born on the Fourth of July, JFK, and Glory enables them to benefit from another medium as a resource in their study of current events and history.

Movies, along with our hands-on activities such as reading, in-class discussion groups, and research projects, give students a well-rounded opportunity to discover the world of history. Movies go beyond dry facts and help bring events “alive.”

Be assured that we will use proper discretion when showing these movies.

Thank you for taking the time to read and sign this permission form.



Student Name______________________

____ Yes, I approve my child’s viewing of curriculum and school appropriate movies rated PG/PG-13/R (circle all that apply).

____ No, I do not approve my child’s viewing of curriculum and school appropriate movies. I understand alternate learning experiences will be provided for my child while the movie is being watched.

Guardian signature/date___________________________


Sample note
We will be showing Glory, which is rated R; however, we are skipping certain scenes which we feel are too intense for our students.

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