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Movie Permission Slip

Georgetown Middle School

Permission to View Film/Video


Dear Families,

Occasionally, film/videos are used in the classroom to illustrate particular

curricular-related concepts and standards.

I am notifying you that we will be watching a film/video in class with a G rating.


Film/Video Title: Soul Surfer (The Incredible True Story of Bethany Hamilton).

Concepts: “Facing Fear” and “Bold Actions”

State Standard/Objective: RL.6.3: Describe how a particular story’s or drama’s plot unfolds in a series of episodes as well as how the characters respond or change as the plot moves toward a resolution. RL.6.2: Determine a theme or central idea of a text and analyze its development over the course of the text; summarize the text. RL.6.7: Compare and contrast the experience of reading a story, poem, or drama to listening to or viewing an audio, video, or live version of the text, including contrasting what they see and hear when reading the text to what they perceive when they listen or watch.


·       Students will create a detailed plot diagram.

·       Discuss characterization, themes, and resolution of conflicts to construct understandings and connections with modern day issues.


Please return the permission slip below on or before Tuesday, October 24, 2017.


6th Grade ELA Team



Child’s Name __________________________________________________

____ Yes, I give my son/daughter permission to view curriculum and school appropriate

film/videos related to classroom content and subjects.


____ No, I do not give my son/daughter permission to view curriculum and school appropriate film/videos mentioned in this letter. I understand alternate learning experiences will be provided for my child while the movie is being watched.


Signature of Parent or Guardian: ______________________________________________

                                           Date: ___________________________________