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 __________
Question
What is the main idea of the content within this form?
Responses
A Willow High School encourages video presentations in the classroom.Willow High School encourages video presentations in the classroom.
B Willow High School does not encourage video presentations in the classroom.Willow High School does not encourage video presentations in the classroom.
C Parents, teachers, and principals must plan together for essential video presentations.Parents, teachers, and principals must plan together for essential video presentations.
D Video presentations require teacher planning and permission from parents and the principal.Video presentations require teacher planning and permission from parents and the principal.