Physical Education Waiver Request
Poudre High School

This form is to be completed and returned to Mr. Aragon after completing step two. If the activity is outside of Poudre High School, a detailed log of hours and activities performed must be submitted with this form. If the activity involves a competitive sport/activity sponsored by Poudre High School, no log is required.

Step One: Work with your counselor to determine a sport/activity that would be appropriate for waiving credit.

Students' Name____________________________________, ID number___________

Grade_______, Phone________________________

Parent/Guardian Signature _________________________________ Date _________

Counselor Signature ____________________________ Date ______________

Sport or Activity _____________________ Dates of Participation _______________

Step Two: Complete your season and get your coach/instructor's signature. If the activity is outside of Poudre High School, complete your detailed log of hours and activities performed.

Coach/Instructor's Signature _____________________________ Date ____________

I guarantee that the above named student has successfully completed the season/activity under my supervision.

Step Three: Return this form completed to Mr. Aragon for a final signature.

Waiver Approved _______ Date _______ Waiver Denied ______ Date _______

Number of Credits: 2.5

Reason (s) for denial:

Principal or designee signature ____________________________Date __________