Lawrence North High School PE II Waiver Application
Student Name______________________________________
Circle One: Performing Arts (list)_________________ Cheerleading
IHSAA Sport (list) ___________________ Dance team(list)_______________
Grade in School:_______________
(Student must meet ALL of the following criteria )
_____Participation in one of the following at Lawrence North: Cheerleading, Dance teams,
an IHSAA sponsored Lawrence North High School sport, or Marching Band
______Completion and application before the start of the student’s junior year unless
otherwise approved by the P.E department chair and the student’s counselor
______Student demonstrates competency in motor skills and movement patterns
needed to perform a variety of physical activities.
______ Student demonstrates an understanding of movement concepts, principles,
strategies, and tactics as they apply to the learning and performance of
physical activities.
______Student participates regularly in physical activity, demonstrated by participation in
over 90% of group activities (injury free), or 66% due to major injury (Lawrence
North Athletic Trainer or physician signature required).
______Student achieves and maintains a health-enhancing level of physical fitness.
______Student exhibits responsible personal and social behavior that respects self and
others in physical activity settings, finishing the season in good standing, free from
code of conduct violations.
______Student values physical activity for health, enjoyment, challenge, self- expression,
and/or social interaction.
Printed Student Name
Student Signature
Date
Printed Parent Name
Parent Signature
Date
Printed Coach/Director Name
Coach/Director Signature
Date
Department Chair Signature
AT or physician signature
(if required)
Final Grade A___________
Did Not Complete________
Coaches or Sponsors: Please submit the completed form to the Grant Nesbit, Director of
Athletics, within two weeks of the conclusion of the activity or sport.
Check One:
Steps in attaining a waiver credit for P.E. II:
1. Prior to junior year, the student will inform their counselor that they wish
to use one of the approved activities to receive credit for P.E. II.
2. The counselor will give the student a credit waiver application.
3. The student will submit the form to the Athletics/Activities office. A list of
those students who have applied for the waiver will be given to the
coach/sponsor at the beginning of the season.
4. The coach/sponsor will indicate if the student has met all the criteria on the
application, sign it, and return it to the Athletics/Activities office.
5. Grant Nesbit will create a class list each semester from applications turned
in and will assign a grade for each student.
6. Students must complete the activity/sport for the credit waiver before the
start of their junior year unless previously approved by Mr. Nesbit and their
counselor.