Observation Permission Form

I hereby grant permission to

______________________________________________to observe and interview the minor child

______________________________________________for educational purposes. I understand that there will not be any identifying information about the child listed in the report (i.e., real name, address, phone number, etc…).

If I have any questions, I understand that I may contact the instructor of the course at any point. I have been given the instructor’s contact information.

By signing this form, not only am I authorizing the EDUC 121 student to observe and interview the minor child and myself, I also authorize that I am the custodial guardian of said minor child and have the ability to give said permission.

Parent/Guardian Signature

________________________________________________________

EDUC 121 Student Signature

________________________________________________________

Date ___/___/_____

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