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 __________ __________
