Physical Education/Wellness Video & Film Permission Form

 

Revised 9/17/2013
Parental Consent Form

 

Your son/daughter will have the opportunity to view the film(s) or video(s) described below. Milford High School policy requires parental notification and consent for minors to view this material. Please review the information provided on this form and indicate your request for exclusion by circling any film you would like excluded, writing “No” next to it and signing at the bottom. Any students (on their own or at parental request) who choose not to take part will be free to do so, and will incur no penalties or consequences for their decision. They will be provided with equivalent alternative educational activities and assignments.

 

If you have any questions or concerns, please contact us at the High School
(673-4201, ext.3281) Thank You.

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Teacher: Darren Fleury, Jean-Guy Letarte, & Meliss Letendre 
Course: Wellness I & II
Show date(s): Through the course of the school year ___________

 

Title of Film/Video: Industry rating:
No 1- Smashed Educational Video- Not Rated
No 2- Miracle of Life Educational Video- Not Rated
No 3- Look Who’s Talking Film-PG-13
No 4-Bang, Bang, You’re Dead Film-PG-13
No 5-The Blind side Film-PG-13
No 6-Juno Film-PG-13*
No 7-The Announcement Not Rated ESPN Documentary*

 

1- Smashed demonstrates the risks of drinking and driving for teens. It depicts the risks of serious injury or death due to driving under the influence. It does contain some graphic content and some strong language by people involved in driving accidents.

2- Miracle of Life is a science video that explains the reproductive systems (male & female) including fertilization and cellular development until birth.

3- Look Whose Talking is a young adult comedy using some adult language and innuendos while depicting life and challenges as a single parent.

4- Bang, Bang, You’re Dead explains how kids can be the most ruthless people. Bullying, suicide and threats against the school are depicted in the movie. A teacher and a friend help guide a student through the troubled times in high school.

5- The Blindside shows hope over racial issues and poverty that are still present in today’s life. Human Kindness is life changing. A true life story of NFL pro football player Michael Oher.

6- Juno exemplifies the life of a pregnant teenager. It deals with choices and decisions that must be faced. Some of the teenage language is crude and can be offensive at times *(only Wellness II junior students).

7- On November 7, 1991, Earvin "Magic" Johnson made people stop and watch him make the stunning announcement that he was HIV-positive and would be retiring from basketball immediately. Director Nelson George gets to the core of this incredible personal journey and explores how Magic continues to thrive two decades later.

 

 

These movies all present facts about life directly related to wellness (health) topics discussed
in classes exploring various units of our district approved curriculum.

PARENT /GUARDIANS: If you do not wish your son or daughter view any film, please return this form via your child. Any student not returning a form will be allowed to view these films.

My son/daughter (print full name) _________________________ does not have my consent to view the film or films (circled ones) described above.

 

Signature:___________________________        Name (please print)______________________________        Date:__________________