Morgan County High School
Parental Permission Form for Movie/Video
Dear Parents and Guardians:
On Click to enter movie date, Click to enter Instructor's Name who teaches
Click to enter Class Name intends to show the movie Click to enter name of movie
which is rated Click to enter rating.
This movie has been chosen to be seen for the explicit purpose of:
Click to enter text.
Movie Rating Description:
G – General Audiences All ages admitted. This movie contains nothing that would offend
parents for viewing by children. Such films may contain only mild violence or crude
humor, and may have no nudity, sex, drugs or coarse (as distinct from impolite)
language. The discrimination/bullying and emotional intensity must be minimal. Alcohol
and tobacco may be used in small amounts by adults in the movie, but not by minors,
especially in older G-rated films. The violence or horror must be cartoonish in nature or
minimal in quantity.
PG – Parental Guidance Suggested Some material may not be suitable for children.
Parents are urged to give parental guidance as the motion picture contains some
material that parents might not find suitable for their pre-teenagers. Such films may
contain some violence, infrequent coarse language, crude situations, suggestive
material, some rude or unsophisticated behavior, discrimination/bullying, thematic
elements, disturbing/startling images, mild horror, action and peril, emotional intensity,
drug references, alcohol, tobacco, brief partial or somewhat complete nudity and/or
implied or some sexual situations.
PG-13 – Parents Strongly Cautioned Parents are urged to be cautious as the motion
picture contains some material that parents might consider inappropriate for children
under 13. Such films may contain moderate to strong violence, horror, action and peril,
strong coarse language, some suggestive material and partial or somewhat complete
nudity, strong rude or unsophisticated behavior, discrimination/bullying, alcohol,
smoking, intense sexual situations, crude situations, thematic elements, emotional
intensity, disturbing/startling images, and/or soft drug use or references.
R – Restricted People under 17 may only be admitted if accompanied by a parent or
guardian. Such films may contain rough and/or persistent violence and suggestive
material, hard language, strong horror, action and peril, strong crude sexual content,
alcohol, tobacco, thematic elements, hard crude situations, emotional intensity,
disturbing/startling images, hard rude or unsophisticated behavior,
discrimination/bullying, sexually oriented nudity, and/or hard drug use.
Please feel free to call the Instructor with any questions or concerns you may have
regarding this issue.
Please sign the form below, indicating whether your child may view or may not view this
movie. (Alternative lessons will be given to students who may not view this movie.) The
student needs to return this signed form before seeing the movie. Only students who
have a signed permission form will be permitted to view this movie.
I, ______________________________________________________________, give my permission for
(Parent/Guardian Name)
____________________________________________________________________________ to watch
(Student’s Name)
____________________________________________________________________________________.
(Name of Movie)
_________________________________________________________ __________________________
(Signature)
(Date)