Syllabus Acknowledgement/Movie Permission Form

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Dear Parent/Guardian of ____________________________________ (print student name CLEARLY):


Throughout the school year films/documentaries will be shown to accompany certain pieces of text and further enhance understanding within the classroom (if time permits). Below are a number of titles that may or may not be shown in your student’s classroom. If any of the material brings about concern, please indicate in the space provided below and your student will be exempt from viewing the specifically mentioned video.


MOVIE PERMISSION-is required for ALL students for movies rated PG-13 and above. It is AGAINST C.U.S.D policy to show any film Rated R. Your signature below indicates permission for your student to participate in these enrichment activities.

Please indicate (with an X) whether your student is a Junior _____ or Senior _____

English 12: Beowulf- Rated PG-13 (first 12 min), Hamlet- Rated PG-13, The Simpson’s- Hamlet, A Knight’s Tale- Rated PG-13, Food, Inc. (documentary), Five People You Meet in Heaven- TV movie (not rated), Aeon Flux- Rated PG 13, and Gattaca- Rated PG 13.


English 11: The Crucible- Rated PG 13, The Yellow Wallpaper- TV movie (not rated), The Simpson’s- The Raven, The Great Gatsby-Rated PG 13, and Raisin in the Sun-TV Movie.


Movie Permission:

Please sign in order to acknowledge that you consent to your child watching the films listed on the outline.



Parent’s Signature: ___________________________________________


* Please indicate in the comment section below if you find any of the above mentioned titles problematic and DO NOT want your child to view that specific title.






In addition, please sign below to indicate that you have read the syllabus (either online or in print) and are aware of all policies and procedures.



Student’s Signature:_________________________________________________


Parent’s Signature:__________________________________________________



Thank you,


Ms. Morgan

English 11 and 12

Syllabus Acknowledgement_Movie Permission Form.docx, 14.53 KB; (Last Modified on July 20, 2016)