CChem+Movie


 * PARENT AUTHORIZATION FOR VIEWING A

 PRERECORDED **MOVIE** OR VIDEO

 (For use with **movies** or videotapes with content

 other than that which merits a "G" **rating**.)  ||   ||


 * ^  ||   || The **movie** or videotape described below will be shown in your child's classroom on _____________________________ . I have provided information about the **movie**/videotape, and am requesting your permission to have your child participate in this instructional activity. Your child will be able to view the **movie**/videotape only if this permission slip is signed and returned. If your child does not participate in viewing the **movie**/videotape, an appropriate alternative educational experience will be provided. Should you have any questions, please contact me. ||   ||^   ||
 * ^  ||   || The **movie** or videotape described below will be shown in your child's classroom on _____________________________ . I have provided information about the **movie**/videotape, and am requesting your permission to have your child participate in this instructional activity. Your child will be able to view the **movie**/videotape only if this permission slip is signed and returned. If your child does not participate in viewing the **movie**/videotape, an appropriate alternative educational experience will be provided. Should you have any questions, please contact me. ||   ||^   ||
 * ^  ||   || The **movie** or videotape described below will be shown in your child's classroom on _____________________________ . I have provided information about the **movie**/videotape, and am requesting your permission to have your child participate in this instructional activity. Your child will be able to view the **movie**/videotape only if this permission slip is signed and returned. If your child does not participate in viewing the **movie**/videotape, an appropriate alternative educational experience will be provided. Should you have any questions, please contact me. ||   ||^   ||


 * ^  ||   ||  Sincerely, ||   ||^   ||
 * ^  ||   ||  Sincerely, ||   ||^   ||
 * ^  ||   ||  Sincerely, ||   ||^   ||


 * ^  ||   || <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;"> ____________________________________
 * ^  ||   || <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;"> ____________________________________
 * ^  ||   || <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;"> ____________________________________

<span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;"> Teacher ||  ||^   ||
 * ^  ||   |||||| <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Video title: <span style="font-family: 'Times','serif'; font-size: 16px;">______________________________________ <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Length (min.): <span style="font-family: 'Times','serif'; font-size: 16px;">_________ ||   ||^   ||
 * ^  ||   |||||| <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Video title: <span style="font-family: 'Times','serif'; font-size: 16px;">______________________________________ <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Length (min.): <span style="font-family: 'Times','serif'; font-size: 16px;">_________ ||   ||^   ||
 * ^  ||   |||||| <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Video title: <span style="font-family: 'Times','serif'; font-size: 16px;">______________________________________ <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Length (min.): <span style="font-family: 'Times','serif'; font-size: 16px;">_________ ||   ||^   ||
 * ^  ||   |||||| <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Video title: <span style="font-family: 'Times','serif'; font-size: 16px;">______________________________________ <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Length (min.): <span style="font-family: 'Times','serif'; font-size: 16px;">_________ ||   ||^   ||
 * ^  ||   |||||| <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Video title: <span style="font-family: 'Times','serif'; font-size: 16px;">______________________________________ <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Length (min.): <span style="font-family: 'Times','serif'; font-size: 16px;">_________ ||   ||^   ||


 * ^  ||   || **<span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Rating **<span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">: <span style="font-family: 'Times','serif'; font-size: 16px;">______ <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;"> An explanation of the **rating**: <span style="font-family: 'Times','serif'; font-size: 16px;">______________________________ ||   ||^   ||
 * ^  ||   || **<span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Rating **<span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">: <span style="font-family: 'Times','serif'; font-size: 16px;">______ <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;"> An explanation of the **rating**: <span style="font-family: 'Times','serif'; font-size: 16px;">______________________________ ||   ||^   ||
 * ^  ||   || **<span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Rating **<span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">: <span style="font-family: 'Times','serif'; font-size: 16px;">______ <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;"> An explanation of the **rating**: <span style="font-family: 'Times','serif'; font-size: 16px;">______________________________ ||   ||^   ||


 * ^  ||   || <span style="font-family: 'Times','serif'; font-size: 16px;">________________________________________________________________________ ||   ||^   ||
 * ^  ||   || <span style="font-family: 'Times','serif'; font-size: 16px;">________________________________________________________________________ ||   ||^   ||
 * ^  ||   || <span style="font-family: 'Times','serif'; font-size: 16px;">________________________________________________________________________ ||   ||^   ||


 * ^  ||   || <span style="font-family: 'Times','serif'; font-size: 16px;">________________________________________________________________________ ||   ||^   ||
 * ^  ||   || <span style="font-family: 'Times','serif'; font-size: 16px;">________________________________________________________________________ ||   ||^   ||
 * ^  ||   || <span style="font-family: 'Times','serif'; font-size: 16px;">________________________________________________________________________ ||   ||^   ||


 * ^  ||   || <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Summary of the **Movie**/Video: <span style="font-family: 'Times','serif'; font-size: 16px;">____________________________________________ ||   ||^   ||
 * ^  ||   || <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Summary of the **Movie**/Video: <span style="font-family: 'Times','serif'; font-size: 16px;">____________________________________________ ||   ||^   ||
 * ^  ||   || <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Summary of the **Movie**/Video: <span style="font-family: 'Times','serif'; font-size: 16px;">____________________________________________ ||   ||^   ||


 * ^  ||   || <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Why I plan to show this videotape: <span style="font-family: 'Times','serif'; font-size: 16px;">________________________________________________________________________ ||   ||^   ||
 * ^  ||   || <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Why I plan to show this videotape: <span style="font-family: 'Times','serif'; font-size: 16px;">________________________________________________________________________ ||   ||^   ||
 * ^  ||   || <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">Why I plan to show this videotape: <span style="font-family: 'Times','serif'; font-size: 16px;">________________________________________________________________________ ||   ||^   ||


 * ^  ||   || <span style="font-family: 'Times','serif'; font-size: 16px;">________________________________________________________________________ ||   ||^   ||
 * ^  ||   || <span style="font-family: 'Times','serif'; font-size: 16px;">________________________________________________________________________ ||   ||^   ||
 * ^  ||   || <span style="font-family: 'Times','serif'; font-size: 16px;">________________________________________________________________________ ||   ||^   ||


 * ^  ||   || <span style="font-family: 'Times','serif'; font-size: 16px;">________________________________________________________________________ ||   ||^   ||
 * ^  ||   || <span style="font-family: 'Times','serif'; font-size: 16px;">________________________________________________________________________ ||   ||^   ||
 * ^  ||   || <span style="font-family: 'Times','serif'; font-size: 16px;">________________________________________________________________________ ||   ||^   ||


 * ^  ||   || <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">My child, <span style="font-family: 'Times','serif'; font-size: 16px;">____________________________________ <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">, has my permission to view the above **movie**/videotape. ||   ||^   ||
 * ^  ||   || <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">My child, <span style="font-family: 'Times','serif'; font-size: 16px;">____________________________________ <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">, has my permission to view the above **movie**/videotape. ||   ||^   ||
 * ^  ||   || <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">My child, <span style="font-family: 'Times','serif'; font-size: 16px;">____________________________________ <span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;">, has my permission to view the above **movie**/videotape. ||   ||^   ||


 * ^  ||   || <span style="font-family: 'Times','serif'; font-size: 16px;">__________________________________________ ________________________
 * ^  ||   || <span style="font-family: 'Times','serif'; font-size: 16px;">__________________________________________ ________________________
 * ^  ||   || <span style="font-family: 'Times','serif'; font-size: 16px;">__________________________________________ ________________________

<span style="font-family: 'New Century Schlbk','serif'; font-size: 16px;"> Parent Signature Date ||  ||^   ||