2025-2026 High School Permission Form – Gilmer Christian Learning Center

Parent /Guardian Permission & Liability Form-2025-2026 School year

Student Information

Student Name *

First

Last

School: Gilmer High School (GHS)

Grade: *

Parent/Guardian Name: *

First

Last

Parent/Guardian Phone: *

Parent/Guardian Email: *

Program Information (Released Time Education)

The Gilmer Christian Learning Center (CLC) is a privately funded 501(c)(3) nonprofit Released Time Education ministry. Participation is voluntary and chosen by the student with parent/guardian permission. CLC receives no funding from the government or the school system. CLC classes are not held on school property; instruction occurs on CLC property during the school day.

Permissions

I give permission for my student to participate in the CLC program *

I give permission for my student to be transported by vehicles to and from school to the CLC facility. *

I give permission for my student to access the Internet during class time at CLC. *

I give permission for my student to be photographed and/or videotaped during CLC activities (for use in publication or ministry communications) *

Student Conversations Disclaimer

CLC staff may be approached by students to discuss personal or spiritual matters. CLC staff are not trained or licensed counselors.

Understanding this, I give permission for my student to voluntarily discuss personal matters with CLC staff *

Technology Notice

CLC may uses Google Classroom and Goole Meet for instruction. Google Meet sessions may be recorded and retained for CLC access only for the safety and protection of students, staff, and the ministry.

I acknowledge and consent to the Technology Notice above *

Field Trips & Service Projects

Field Trips & Service Projects: I give permission for my student to participate in short, supervised activities during the scheduled CLC class period, which may include walking or being transported from the CLC campus to a loval restaurant or to a local service project. I understand students will return in time for their next scheduled class.

I give permission for short field trips/service projects during CLC class period. *

Assumption of Risk & Liability Acknowldgment

I acknowldege that participation in the CLC porgram involves risk and may result in injury or illness, including possible exposure to infectious or communicable diseases (including but not limited to COVID-19), I voluntarily assume these risks on behalf of my student and agree to release and hold harmless the Gilmer Christian Learning Center (CLC), its staff, board members, volunteers, and affiliates to the fullest extent permitted by law.

Parent/Guardian Initials: *

Enrollment Permission Period

Students may take CLC for one or more semesters.

I give permission for my student to participate in the Gilmer Christian Learning Center (CLC) program for the 2025-2026 school year. This may be for one or both semesters. *

I understand that:

Participation is vountary, and my student may discontinue at any time by notifying the CLC.
CLC is not part of the school system, and the school is released from liability related to participation in Released Time classes.
CLC is soley reponsible for instruction, transportation, supervision, and conduct of its program

Emergency/ Medical Information

Please list any allergies, medical needs, or other concerns.

Emergency Contact Name: *

First

Last

Emergency Contact Phone: *

Relationship *

Signatures

Parent/ Guardian Signature: *

Clear Signature

Date: *

Student Signature: *

Clear Signature

Date / Time *

Date

Time