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 __________
1) 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)
Based on the form, what inference can you make from the comparison of these two questions?
A) Video presentations require planning.
B) Video presentations are required at least one time.
C) Videos presentations are used during free time and after tests.
D) It is essential to ask students questions about each video presentation.
