Policies » Section I: Instruction » IHAM-R: Health & Physical Education Exemption: Opt-Out Form

Policy Date: 01/09/2018

ASD File: IHAM-R
HEALTH & PHYSICAL EDUCATION INSTRUCTION EXEMPTION
OPT-OUT FORM

I, ________________________ (parent/guardian) request that my child, __________________
be excused from participating in certain units of health or physical education instruction due to religious reasons or religious objections.

I request that the District waive the class attendance of my child in a class or courses on the following subjects/units:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Please identify the grade level, class, and building. ___________________________________
____________________________________________________________________________.

I understand that I am requesting the school to excuse my child from certain units of curriculum that are required by state law. I further understand that in lieu of receiving instruction in this unit of health or physical education, my child may be required to receive alternative learning in health or physical education that is sufficient to enable my child to meet state requirements for health education. I further understand that this opt-out exemption is only valid for the school year in which it is signed and subsequent waivers may be necessary.

________________________________ __________________________________
Parent/Guardian Signature Administrator Signature

Date Received ______________

This form is exempt from disclosure under the Right –to-Know law, RSA Chapter 91-A, and RSA 186:11, IX-e (Duties of the State Board)

Adopted: June 9, 2009
Revised: January 9, 2018