Reeltown Middle School
Parent/Guardian Student Permission Form

I, the undersigned Parent/Guardian, give permission for my student enrolled at Reeltown Middle School to attend Released Time Bible Education ("RTBE") classes sponsored by School Ministries Alabama ("School Ministries") and First Baptist Church - Reeltown ("FBC Reeltown), with classes held every Thursday, starting October 10th, 2024, from 12:20 pm to 3:00 pm at Reeltown Fire Department, 4084 AL-120, Notasulga, AL 36866. I understand my child will walk to and from RTBE classes at the Fire Department accompanied by volunteer adult escorts and/or FBC Reeltown or SMA staff, and that vehicle transportation is understand is NOT provided by Tallapoosa County School District or Reeltown Middle School. This is my consent to allow my student to attend RTBE classes for the 2024-2025 School Year.

I understand there may be occasions when photos or video may be taken during this RTBE Bible class; I consent for School Ministries and its agents to use and publish, without charge, photos, videos, print material, or other media that may include images and words of or about my child.

I understand and agree that:

1. This class is not designed to conflict with required core classes, and that my student is responsible for school class assignments that may be missed during RTBE Bible classes.

2. This RTBE Bible class will be placed in my child's school class schedule. This means:

a. I may withdraw my permissions for my RMS student to attend future RTBE Bible classes with at least 48-hour written notice to School Ministries and RMS.

3. School Ministries may withdraw my student from the class, with at least 48-hour written notice to the student's parent/guardian and RMS, if circumstances (e.g., unresolved behavioral issues) require.

I understand that any supporting educational accommodations or interventions provided to my student by Reeltown Middle School or Tallapoosa County Schools are not available or otherwise provided to my student during their attendance at this specific RTBE class, including students required to be supported by a school nurse or paraeducator during the school day. Food allergies do not require a School nurse to accompany your child; however, that information is requested below so we are aware and prepared if necessary.

Please complete the following:

My child has the following food allergies.

Student's First Name

Student's Last Name

Today's Date

First and last name entry will count as the Student's electronic signature.

Parent/Guardian's First Name

Parent/Guardian's Last Name

First and last name entry will count as your electronic signature.

Today's Date

Parent/Guardian Phone Number

Parent/Guardian Email

Parent/Guardian Street Address*

Emergency Contact' First Name

Emergency Contact' Last Name

Today's Date

Emergency Contact's Phone Number

Emergency Contact's Email

After review and acceptance by SMA, a PDF copy of your completed form will be sent to the email address provided.

Thank you for your patience.

By submitting this form with my electronic signature I confirm my acceptance of its terms and conditions.

Thank you for submitting your student's permission form. If you have any questions or concerns, please email Mark Warner at mark@smalabama.org.

Reeltown Middle School Parent/Guardian Student Permission Form

Parent/Guardian Street Address*

Reeltown Middle School
Parent/Guardian Student Permission Form