RELEASED TIME ENROLLMENT FORM
TO ENROLL YOUR CHILD IN RELEASED TIME - PRINT OUT THIS PAGE AND MAIL IT TO: CBM Released Time, PO Box 378, Carmichaels, PA 15320
RELEASED TIME IS OFFERED IN:
ELEMENTARY SCHOOLS
GREENE COUNTY - Aleppo, Graysville, Waynesburg, Perry, Bobtown, Carmichaels, Jefferson Morgan
FAYETTE COUNTY - AL Wilson, Plava, Masontown, Friendship Hill, Smithfield and D. Ferd Swaney
SECONDARY SCHOOLS
GREENE COUNTY - West Greene, Waynesburg, Margaret Bell Miller, Carmichaels, Mapletown, Jefferson Morgan
FAYETTE COUNTY - Albert Gallatin South & North Middle schools, AG High School
Name of Child _______________________________ Birthday___________
Name of Parent/Guardian ________________________________________
Address_____________________________________________________
City ___________________________ State _______ Zip Code__________
Phone # ____________________________________
School _____________________________________ Grade _______
_____ I would like my child enrolled in the Released Time Bible Program and Mailbox Club.
_____ I would just like my child to receive a camp brochure.
_____ I might be available as a volunteer for Released Time.
I give my child, named above, permission to be released from school for one hour per week to attend Bible classes. I also give CBM, the CBM provider, permission to use pictures or videos of my child taken in class for promotional purposes.
SIGNATURE OF PARENT _____________________________________________ DATE _________________