Upper Arlington High School
1650 Ridgeview Road • Upper Arlington, Ohio 43221 • 614.487.5200 • 614.487.5238 (fax)
PE WAIVER FORM
Students who have participated in District sponsored interscholastic athletics, marching band or
cheerleading for at least two full seasons while enrolled in grades 9-12 may be excused from the high
school physical education requirement. Participation is defined as being active in 90% of in-season
team activities, competitions and practices. One season of participation would be equivalent to ¼ unit of
instruction. Ohio Revised Code defines District sponsored interscholastic athletics, marching band or
cheerleading as any high school athletic team, high school cheerleading squad or high school marching
band of the Upper Arlington City Schools that participates in the District’s regular athletic season(s) and
is operated under the supervision of a Board employee. Club activities, club sports and/or intramurals
are not considered part of District sponsored athletics, marching band or cheerleading.
Disclaimer: Participation in District sponsored interscholastic athletics, marching band or cheerleading
seasons prior to the 2013-2014 school year cannot be used to fulfill the physical education requirement.
If you choose to exempt the credit for physical education, you must return this form to your school
counselor after completion of both seasons with the appropriate signatures. Please note that you
will not be receiving credit for physical education. Instead, you will need to take another class equal to
½ credit to earn the 21 credits needed for graduation. It is the student’s responsibility to obtain the
required signatures and return the form to their counselor!
NAME: ________________________________________
ID #______________________
___________________________
_______________________________
Signature of Parent & Date
Signature of Student & Date
Season #1: ____________________________
Sport, marching band or cheerleading
_______________________________
Season (fall, winter, spring) and year of participation
____________________________
Signature of Athletic Director or Band Director & Date
Season #2: ____________________________
Sport, marching band or cheerleading
_______________________________
Season (fall, winter, spring) and year of participation
____________________________
Signature of Athletic Director or Band Director & Date
____________________________
Signature of Counselor & Date
If a copy of this completed form is not on file with the counseling office, the student will need to
complete two PE courses for graduation.
Copy for student, counselor, cumulative file