Student Name:_______________ Grade:__________
Parent/Guardian:_______________ Phone #:__________
Please list the curricular objective(s) from which you wish to have your child excused and the class or grade in which each is taught. An example is provided for you to follow.
Objective Class/Grade
Example To understand the consequences Health Education
of responsible and irresponsible
sexual behavior.
1.
2.
3.
4.
5.
I have reviewed the Human Growth and Development program goals, objectives, and materials and wish my child to be excused from class when these objectives are taught. I understand my child will incur no penalty but may be required to complete an alternative assignment that relates to the class and is consistent with assignments required of all students in the class.
Signed:_________________________ Date:_______________
Parent or Guardian
Signed:_________________________ Date:_______________
School Administrator
Approved: 10/16/14
Reviewed: FY 2016-2017, August 15, 2016, June 28, 2021
Revised: 02/24/17