Pe Exemption Form - Austintown Local Schools (Page 4 of 4) in pdf

Pe Exemption Form - Austintown Local Schools Page 4

AUSTINTOWN FITCH HIGH SCHOOL PHYSICAL EDUCATION WAIVER

Waiver Intent

Please print your responses to the following requested information. Complete and return to

the Guidance office PRIOR to the following dates established for each season:

Fall/Winter/Spring SportsMay 1st.

Name:_________________________________________________________

Graduation Year____________________________

PE Waiver Season Completion: (Circle One) 1 or 2

Activity_______________________________Coach/Advisor_________________________

IT IS UNDERSTOOD THAT TWO SUCCESSFUL SEASONS MUST BE COMPLETED TO

WAIVE THE PHYSICAL EDUCATION GRADUATION REQUIREMENT AND THAT NO

CREDIT IS EARNED FOR THE WAIVED ACTIVITY.

Student’s signature:___________________________________________________

Parent’s signature:____________________________________________________

Date:___________________________

This Portion should be Completed by the Athletic Director or Marching Band Director

Verification that the abovenamed student has successfully completed each season of

activity.

Activity:________________________________________ Date of Completion: __________

Athletic Director’s/Marching Band Director’s signature:______________________________

Head Coach’s Signature: _____________________________________________________

Date: _________________________________

Pe Exemption Form - Austintown Local Schools Page 4