U. S.  HISTORY THROUGH FILM AND THE WORLD WIDE WEB

PARENT  PERMISSION FORM

Student Name  (Please Print)__________________________________________        Date_____________

Student Signature                 __________________________________________

As the parent or guardian  of the above student, I understand that  participation in the U. S. History Through Film and the World Wide Web program  may occasionally  involve the viewing of R-rated films dealing with United States history.  I understand that participation in the United States History Through Film and the World Wide Web program is strictly voluntary and that viewing the R-rated films will be done at home or some other locale other than school.  This program is an opportunity for students to be involved in an alternative approach to the study of United States history   and although some work may be done at school, viewing R-rated films  is not allowed.  As the parent and guardian of the above student, I give permission for them to view R-rated films pertaining to the programs history units and assignments.

Parent of Guardian Name  (Please Print)_________________________________          Date____________

Parent or Guardian Signature                 _________________________________