PARENTAL CONSENT FORM FOR READING MATERIAL
_____________________________
Student’s name
__________________
Bar code
__________________
Date
FROM: Talawanda
Middle School Media Center
Dear
Parent / Guardian,
Your son
/ daughter has requested a book from our
Need Parental Consent shelf. The books on this shelf,
although informative, do have some explicit sections
dealing with sensitive subject matter. If you give your
child permission to check out these books, please fill out
the information below. If you have any questions concerning
the matter, please call me at 273-3359.
Thank you,
Monica Greene
Media Specialist
_______________________________
Student’s Signature
* By signing this form I am agreeing that my son / daughter
has permission to
check out any material from this section of the TMS Media
Center.
_______________________________
Parent / Guardian Signature *