Physical Education Waiver Form

Physical Education Waiver Form — Form Fields

This education template includes 12 fields. Students or parents request a waiver or modification of physical education requirements due to medical conditions. Free to customize and use on ZenBuild.

• Student Full Name (text, required)
• Student ID Number (text, required)
• Grade or Year (text, required)
• Parent or Guardian Name (text, required)
• Contact Email (email, required)
• Phone Number (text, required)
• Waiver Type Requested (dropdown selection, required) — options: Full PE Waiver, Modified Activities, Temporary Exemption
• Medical Reason for Waiver (long text, required)
• Treating Physician Name (text, required)
• Physician Phone Number (text, required)
• Doctor's Note or Medical Documentation (file upload, required)
• Requested Waiver Period (text, required)