Pelham Park Middle School
Parent/Guardian Student Permission Form

Our enrollment for Pelham Middle School has been filled. If you are interested in a future class please contact kylie@smalabama.org or call kylie at (205) 447-9355.

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

Today's Date

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

Parent/Guardian Phone Number

Parent/Guardian Email

Parent/Guardian Street Address*

Emergency Contact's First Name

Emergency Contact's 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 kylie@smalabama.org.

I, the undersigned Parent/Guardian, give permission for my student enrolled at Pelham Park Middle School (PPMS) to attend Extended Learning Opportunity ("ELO") Bible education sponsored by School Ministries Alabama ("School Ministries"), with classes held Times, Days at Church Name, Address. I understand that School Ministries will provide transportation from PPMS, but that I, the undersigned, will be responsible for picking up my student at Church Name at time after class. Students will NOT be returned to PPMS after class, and School Ministries will NOT provide transportation to any student's home or any other location after class.

Classes will meet every second Thursday according to the following schedule:

Class Dates

I understand there may be occasions when photos or video may be taken during this ELO 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 ELO Bible classes.

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

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

b. If no such prior notice has been given to withdraw my student from all future ELO Bible classes, and I wish my student to avoid attending a scheduled class, I must sign my child out of PPMS before time on that day of the class.

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

I understand that any supporting educational accommodations or interventions provided to my student by Pelham Park Middle School or Pelham City Schools are not available or otherwise provided to my student during their attendance at this specific ELO 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:

Pelham Park Middle School Parent/Guardian Student Permission Form

Parent/Guardian Street Address*

Pelham Park Middle School
Parent/Guardian Student Permission Form