Released Time Character Building (RTCB)How did you find out about us?Word of MouthWebsiteAt SchoolAt ChurchSocial MediaThe semester you are signing up your child2024 (August-Deccember)2025 (January-May)Student Information:Student's Name(Required) First Last Current grade level of student?(Required)2nd1stKindergartenName of Teacher(Required)Parent/Guardian Contact Information:First Parent Name(Required) Prefix Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Last Second Parent Name(Required) Prefix Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Last Email(Required) Cell Phone(Required)Home PhoneWork PhonePreferred Phone(Required)Cell PhoneHome PhoneWork PhoneYour Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Emergency Contact Name(Required)Emergency Phone(Required)Medical Information:Does your child have any allergies or medical conditions that we should be made aware?(Required)Anything else we need to know? Please check here if the above information cannot be shared with the teachers and teacher's assistants. Please check here if your child cannot be included in pictures and video used to promote RTCB.Parental / Guardian Consent: I agree to the below statements:1. I give permission for my child to participate in the RTCB Program in his/her school. I hereby request my child (named on the form above) to be excused from his/her public school each week for Biblical character instruction in the RTCB Program. 2. I understand my child will be transported to the place of instruction by the RTCB team. 3. RTCB's volunteer staff will serve in loco parentis (in place of a parent) for me to confirm to my child's attendance at the RTCB Program. 4. I understand that my child may be removed at any point from RTCB upon written notice from the parent/guardian and likewise RTCB has the right to remove any student from the program for disciplinary issues. 5. RTCB will in no way be responsible for medical treatment or liability resulting from physical conditions existing prior to my child attending the RTCB Program. 6. I give permission to RTCB to act on my behalf in my child's best interest in the event of an accident or emergency. I give my permission to the hospital and/or doctor to treat or operate on my child in the event that I cannot be reached.Δ
