SAMPLE FORM - Education & Early Development



This permission slip is included for your use if permission is needed in accordance with your school district policy. Permission slips should not be included with your performance review. They are for your records only.

Permission to Videotape

Dear Parent/Guardian:

As part of obtaining my teacher certification, I am required to submit two videotapes of lessons taught in your child’s class to the Alaska Department of Education & Early Development. The primary focus of the videotapes is on my instruction and not on the students in the class. During the course of videotaping, your child may appear on the videotape.

I am requesting your permission to allow your child to participate as part of the videotaping of my classroom instruction. All videotapes will be kept confidential.

Sincerely,

____________________________________________

(Your child’s teacher)

Permission Slip (Return to your child’s teacher)

Student name____________________________________________________________

Address__________________________________________________________

School/Teacher____________________________________________________

I am the parent/legal guardian of the student named above. I have received and read your letter regarding the videotaping for teacher certification.

❑ I give permission to you to include my child’s image in videotape as he or she participates in your class.

❑ I do not give permission to videotape my child.

Signature of parent or guardian____________________________________________

Date_________________________________________

Permission slips should not be included with your performance review. They are for your records only.

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