Parent Signature
Health Movie Permission Slip
2013-2014 School Year
Date
Print Student Name
Dear Parent/Guardian,
This letter is being sent to you in compliance with the District’s Board
Policy (6161.11) requiring parents/guardians to approve the intended use of
filmed programs in any format (including bit not limited to videocassette,
16mm film, CD/DVD, broadcast television, electronic media, computer
software or streamed file) not currently adopted/approved as part of the
core instructional materials. The entire policy can be accessed at:
http://www.fremontk12.ca.us/board policies.
Your child is currently studying Health. The goal is to promote wholesome
attitudes toward his/her own health, both physical and mental, and that
the information received by the student will help him/her make intelligent
decisions about life long habits. It is our intention to show the following
movies:
1.) Mean Girls which has a MPAA or like rating of PG-13 because of
rude/suggestive material and language.
2.) SuperSize Me which has a MPAA or like rating of PG-13 because
of language, sex/drug references and a graphic medical procedure.
Please return this completed permission form to your child’s teacher.
Students exempted from this showing will be required to complete an
alternative assignment similar in content to the lesson being taught.
Should you have any questions regarding the program listed above, please
contact your child’s health teacher.
(Teachers Signature)
(Principals Signature)
I give permission for my child to watch the following movies:
Mean Girls
Yes
No
SuperSize Me Yes
No
Health Movie Permission Slip
2013-2014 School Year
Print Student Name
Dear Parent/Guardian,
This letter is being sent to you in compliance with the District’s Board
Policy (6161.11) requiring parents/guardians to approve the intended use of
filmed programs in any format (including bit not limited to videocassette,
16mm film, CD/DVD, broadcast television, electronic media, computer
software or streamed file) not currently adopted/approved as part of the
core instructional materials. The entire policy can be accessed at:
http://www.fremontk12.ca.us/board policies.
Your child is currently studying Health. The goal is to promote wholesome
attitudes toward his/her own health, both physical and mental, and that
the information received by the student will help him/her make intelligent
decisions about life long habits. It is our intention to show the following
movies:
1.) Mean Girls which has a MPAA or like rating of PG-13 because of
rude/suggestive material and language.
2.) SuperSize Me which has a MPAA or like rating of PG-13 because
of language, sex/drug references and a graphic medical procedure.
Please return this completed permission form to your child’s teacher.
Students exempted from this showing will be required to complete an
alternative assignment similar in content to the lesson being taught.
Should you have any questions regarding the program listed above, please
contact your child’s health teacher.
(Teachers Signature)
(Principals Signature)
I give permission for my child to watch the following movies:
Mean Girls
Yes
No
SuperSize Me
Yes
Parent Signature
No
Date