25-26 Middle School Permission Form – Gilmer Christian Learning Center

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

Student Information

Student Name *

First

Last

School: Clear Creek Middle School (CCMS)

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 (Please Check)

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 (for instructional purposes). *

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

Student Converstaions 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 use Google Classroom and Google Meet for instruction. Google Meet sessions may be recorded and retained for CLC accesss 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

I give permission for my student to participate in short supervised activities during the scheduled CLC class period, which may inlcude: wallking, or being transported for the CLC campus 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 the CLC class period. *

Assumption of Risk & Liability Acknowledgment

I acknowledge that participation in the CLC program 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 quarters. Please select ONE option below: *

Full School Year Permission (2025-2026): I give permission for my student to participate in CLC any quarter this school year, as scheduled/available
Quarter-by- Quarter Permission Only:

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 (voluntary participation): *

Clear Signature

Date *