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 Health Education/6
and irresponsible sexual behavior.
1.
2.
3.
4.
5.
6.
7.
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: _________________________________________ Date: _________________
(Parent or Guardian)
Signed: _________________________________________ Date: __________________
(School Administrator)
