Student Name:___________________________________ Grade:__________
Parent/Guardian:___________________________________ Phone #:___________________
Please list the curricular objective(s) from which you wish to have your child excused in the class or grade in which each is taught.
Proposed Alternative Activity:
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.
Parent or Guardian
Approved: 9/23/2019 Reviewed: Revised: