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
Ex. To understand the consequences of responsible and irresponsible sexual behavior. Health Education/6
1. __________________________________________________. ________________________
2. __________________________________________________. ________________________
3. __________________________________________________. ________________________
4. __________________________________________________. ________________________
5. __________________________________________________ ________________________
6. __________________________________________________ ________________________
7. __________________________________________________. ________________________
8. __________________________________________________ ________________________
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/will 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:(Parent or Guardian) __________________________. Date: _____________
Signed:(School Administrator)_________________________ Date: _____________
Approved: 12-16-2015 Reviewed: 11/13/2024 Revised: ____________________
