CM Parental Permission to Participate in Released Time Bible Education

Student Participant's Name

First NameLast Name

Released Time Bible Education will take place once a week for middle school students during the Fall of 2026 and Spring of 2027.

Released Time Bible Education is open to 6, 7, & 8 graders who have a study hall or an elective during the second period.

This program is not affiliated with Clinton-Massie School District but is sponsored by 1Mission Clinton County. If a child has Released Time Bible Education scheduled during their lunch period, a free lunch will be provided by 1Mission Clinton County.

Released Time Bible Education in Wilmington, Ohio is a project of 1Mission Clinton County (www.onemissioncc.org) to provide Bible education, off school premises, by parental consent, during school hours made available by the 1952 Supreme Court Ruling allowing and recognizing the constitutionally protected right of parents to direct the religious education of their children.

During Released Time Bible Education the students will be chaperoned and escorted off campus to a nearby facility to receive religious education. At the end of the allowed time, the students will be chaperoned and escorted back to the school to resume their school schedule.

Grade the student will be in for the 2026/2027 school year:

Child's Allergies, medical problems, or food restrictions

If your child has none, write NONE

Does your child have any special needs or need special accommodations?

If not, write NONE. If so, please specify.

Does your child regularly attend church? If so, where?

If your child does not regularly attend church, write "NO."

What size t-shirt does your child wear?

1. Released Time Bible Education Volunteers: All volunteers have been screened and had a background check.

2. Transportation: Released Time Bible Education will be held in a rented room of the annex.

3. Consent: I/We understand my child will be participating in Released Time Bible Education that will involve reading of the Bible, prayer, and discussion about faith. I understand that my child may be photographed during Released Time Bible Education and the photos may be used on social media and in promotional efforts for 1Mission Clinton County and Released Time Bible Education.

Is your student allowed to have their photo or video taken to be used in our Released Time Bible Education or 1Mission Clinton County publications in print or online.

May we include your student in a group chat or text chain with our volunteers and other students?

Is your student allowed to have their photo or video taken to be used in our Released Time Bible Education or 1Mission Clinton County publications in print or online.

4. Insurance:

I/We represent that the child is a) covered by insurance through my/our own insurance carrier; or b) that I/We am/are personally financially responsible for any and all medical costs incurred as a result of the child's injuary while participating.

5. Emergencies:

If the above-named child requires any emergency medical treatment or procedures during Released Time Bible Education, I hereby consent to and authorize the above-named volunteers to make any decision and take any action to arrange for such procedures or treatments in the discretion of the volunteers.

In the event of an emergency need for a student to be picked up by a parent, during Released Time, our volunteers will escort the student back to the school office to be released from school.

6. Release
I, the undersigned, am the parent or legal guardian of the child/youth named above. For any situation, I assure that I will be available for the phone call at the contact listed below. As a parent or legal guardian, I affirm that I have been completely informed of the Released Time Bible Education child/youth will participate. I understand the general structure of the Released Time Bible Education and do not need to be informed of each and every activity. Phone Number

I hereby voluntarily release, forever discharge the Clinton-Massie School District organization, corporation, its officers, directors, employees, volunteers and agents and 1Mission Clinton County organization, the corporation, its officers, directors, employees, volunteer and agents from any and all claims, demands, or causes of action, which are connected with my child's participation in the Released Time Bible Education or the use of the equipment and facilities. I agree to pay for any and all medical expenses incurred and give permission to the doctor or health care professional to provide medical care if necessary. The information I've given in this form is complete and accurate. By signing this form, I confirm that I have fully informed myself of the contents of this Parental Consent and Release Form by reading it before I signed it. I warrant that I possess all the rights, powers, and privileges of a parent or legal guardian necessary to execute this document with binding legal effect.
Date

Parent/Guardian Full Name

First NameLast Name

2nd Parent/Guardian Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Email

example@example.com

Parent/Guardian Phone Number

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

Parent/Guardian Work Phone Number

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

2nd Parent/Guardian Phone Number

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

2nd Parent/Guardian Work Phone Number

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

Emergency Contacts:

If, in the event of a emdical or other emergency, I am unable to be reached by telephone at my home or work telephone listed above, I authorize the activity supervisor or volunteers to contact me through the emergency contact(s) listed below.

Emergency Contact Name

First NameLast Name

Relationship to student

Emergency Contact Phone Number

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

2nd Emergency Contact Name

First NameLast Name

2nd Emergency Contact Relationship to student

2nd Emergency Contact Phone Number

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

I, the parent/guardian, hereby attest that I have carefully read this permission to participate, understand its contents, and agree to its terms and conditions.

Date