Video Use in the Classroom

Parental Release Form

There may be times when videos are used in the classroom. There are some
videos that relate to subject areas that may have a PG or PG-13 rating (middle
and high school students only.)
For example, fourth grader may read the book, Indian in the Cupboard, and the
teacher may want to show the video for comparison purposes. That video is
rated PG.
Please let us know if your child has your permission to view videos with a PG
rating or in the case of middle school and high school students a PG-13 rating.

Elementary School
Students Name:_____________________________________
Teacher:____________________________________________
_______ Yes, my child may watch videos with a PG rating.
_______ No, I do not wish my child to watch videos with a PG rating.
Parent/ Guardian Signature:

Date:

_________________________________

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