Sample - Parent Permission Form

IMPORTANT- This form must be copied onto your school letterhead.
Please keep the original at the school, and bring along a copy of each permission form to the Action Research session, as we need a copy of the permission forms for CEO/Uni Melb records.

PARENT CONSENT FORM

I / We give consent for __________________________________________________
(Full name of child)

to be involved in the activities related to the Literacy Intervention Action Research Project

being conducted at _______________________________ .
(Name of the school)

The nature of the activities have been explained by the relevant school staff
member.

I understand that the completed Action Research may be posted on the University of Melbourne website and that the school name and all students’ names will be removed from the report.

I understand that my child may be withdrawn from the classroom for these
activities.

I understand that I can withdraw my consent at anytime by notifying the
school principal.

Signature of parent(s) / guardian(s): 1.____________________________

2.____________________________

Date: __________________________

Principal's endorsement: _________________________

Date: __________________________


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