What is the proposed solution if a student does not have parental permission? A) The will be notified. B) The principal will be notified. C) The video will not be broadcast to the class. D) The student will be provided with an alternate activity.
Video Presentation Permission Form
Mary O'Dell
Video Broadcast Permission Form
Willow High School
Teacher's Name: Date:
Name of Video:
Video rating - G PG PG-13 R NR (not rated) Unknown
(You must have signed parental permission slips for ratings above PG-13)
What alternate activity will be provided for any students who do not have parental permission?
How was the video acquired?
taped from TV / Cable date ()
rented (I have permission to show it.)
owned by the school
teacher owned
other (explain)
Length of video Date (s) to be shown Blocks (s) you will be showing this video - 1st 2nd 3rd 4th (Circle all that apply)
What essential question (s) are you studying and how will this video relate to them ?
What follow-up activities are planned for the video? (1 is required)
Teacher's Signature
The teacher signed above accepts responsibility for copyright compliance for broadcasting this video.
Principal's signature (or designee)
Date
Approval is required for materials not owned by the school
Approved Denied
Video Presentation Permission Form
Mary O'Dell
Video Broadcast Permission Form
Willow High School
Teacher Name: Date:
Video Name : Video
Score - G PG PG-13 R NR (Unrated) Unknown
(Parental permission required to login slides above grades 13 and older)
What alternative activity will be provided for students who do not have parental permission?
How is the video acquired?
Recorded TV / cable dated ()
Rented (I do not have permission to show it.)
School
property Teacher owned
Other (explain)
Length of video Date (s) shown block (s) video is shown - 1st 2nd 3rd 4th (circle all that apply)
What essential question (s) are you studying and how will this video relate to them?
What follow-up activities are planned for the video? (1 required)
Teacher Signature
The teacher signed above accepts responsibility for copyright compliance for the broadcast of a video.
Principal's (or designee) signature
Date
Approval is required Materials are not school property
Approved Denied
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