JCMHS MMAD Permission Form

Attention all Students:

You are invited to participate in the Millen Make-A-Difference (MMAD) program. This is a weekly ministry program that meets during lunch on Thursdays or Fridays. Lunch will be provided by the school lunchroom.

This program is voluntary; therefore, you must have signed permission from a parent or guardian to participate. The program is located across the street from the school at the Jenkins County Ag Center. This is NOT a school function of Jenkins County School System. Millen Make a Difference is a not-for-profit organization located in Millen, GA.

Beginning in August, the schedule is as follows :

Thursdays - 6th grade followed by High School

Fridays - 7th and 8th grade

Student's Name

First NameLast Name

Parent/ Guardian's Name

First NameLast Name

Parent/ Guardian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Grade Level

Homeroom Teacher (Middle School Only)

Church

MMAD wants to use photos/videos from regular meetings and special events to post on social media. Please indicate below if MMAD has permission to use photographs, images, or videos of your student?

I volunteer to participate in this weekly ministry program during my lunch period. I realize that I am making a commitment to attend the Millen Make-A-Difference program. I am aware that MMAD is a privilege and requires responsibility on my part. I realize this privilege may be lost if I choose to abuse it at any time.

Student's Signature

I understand that this is a voluntary program, and I give my child permission to participate in MMAD on a weekly basis.

Parent's Signature

JCMHS Millen Make-A-Difference Permission Form