From Classbrain.com's

About Movies in the Classroom
Basic Movie Permission Slip
By Melissa Gruber
Aug 15, 2006, 10:22 PST

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Your School
Movie/Video Permission Form

Request Date:__________________________________________

Teacher Name:_________________________________________

Name of Movie/Video:____________________________________

Rating on Movie/Video:___________________________________

Reason for showing the Movie/Video:________________________
___________________________________________________
___________________________________________________
___________________________________________________

Date of viewing:_________________________________________

Teacher Signature:_______________________________________

Student Name:__________________________________________

Parent/Guardian Approval:_________________________________

Your School
Movie/Video Permission Form

Request Date:__________________________________________

Teacher Name:__________________________________________

Name of Movie/Video:____________________________________

Rating on Movie/Video:___________________________________

Reason for showing the Movie/Video:________________________
___________________________________________________
___________________________________________________

Date of viewing:_________________________________________

Teacher Signature:_______________________________________

Student Name:__________________________________________

Parent/Guardian Approval:_________________________________

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