EXEMPTION FROM REQUIRED INSTRUCTION REQUEST
NEPN/NSBA Code: IMBB-E 

(This form is to accompany Policy IMBB)

This form must be completed each year in which the parent/guardian wishes to limit their child’s participation in required instruction. This form expires on the final student day of the academic year in which it is completed.

 

Student name:                                                                          Grade:             

 

I wish to restrict my child’s participation in instruction on the following topics:

The reason for this request is:                                                                                                   

                                                                                                                                               

                                                                                                                                               

                                                                                                                                               

 

_____ My child has been made aware of this request.

 

Parent/Guardian name: _________________________________________

 

Parent/Guardian signature:___________________________________________ 

Date:___________________________________

 

 Adopted: February 8, 2024