Film Permission Slip

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Roxbury High School

Social Studies Department


Mr. McPhee
US History II A

May 6, 2010

Dear Parent/Guardian:

We are currently studying the World War II Era in our United States History class. Since
we are covering this important topic, I have chosen to show part of the film, Saving
Private Ryan and Patton, in class to provide a portrayal of the subject matter. However,
due to strong war violence, and adult language, this film has received an R rating.

School policy states that in order to show a movie that is rated R, caregivers must
indicate their approval in writing even if students are 17 or older. Students who do not
have permission slips will be given alternate assignments during the duration of the film.
Please indicate your approval by checking off your approval for the student to watch the
film or your wish to have them be given alternate assignments instead. Thank you.

Student Name: _________________________________________ Period: _______

_______ Yes, my student is permitted to watch the film and participate in the
assignment that will come with the watching of the movie.

_______ No, my student is not permitted to watch the film. Instead, I wish for
them to be given alternate assignments not related to watching the movie.

Parent/Guardian Name: ____________________________________________________

Parent/Guardian Signature: _________________________________________________

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