I understand that my child will be attending ‘Teen Scene’ at the Benton County Library.  I further understand that part of the programs will include movies, based on books or chosen book themes, and that these movies will be rated above PG.  By my signing, I agree for my child to participate in this program and view the materials chosen by the library staff.  I understand that I will have advance knowledge of the movie my child will see, and the rating, and may choose not to have my child participate.

Name of Child______________________
Name of Parent_____________________
Parent Signature____________________
Date______________________________

The ‘Teen Scene’ Program for this quarter will be held on ___________________(date)
The theme for this program is ___________________.
The library will be showing the movie _________________________________ which is rated _______________.
The program will start at _____________ and end at _____________ (time), please be prompt in picking your children up at the library.

We will not be leaving the library for any associated activities with this program.
OR (circle one)
We will be leaving the library for the following activity____________________. 
We will travel by school bus to_______________________________________ at _______________ (time)

By my signature below I give permission for my child ________________________ to participate in the program outlined above, see the movie, and ride the bus to attend associated activities, and state that I have read the plan and agree to the program for this quarter.
(Information between the two * above will need to be editable by us to fill in the blanks so they can print it off complete and ready to turn in, please)

Name of Parent ______________________________
Parent Signature______________________________
Emergency Contact Number____________________
Childs Name________________________________

*All permission slips and registration for programs must be completed and turned in one week before the program to guarantee your child’s space.