On [Date] I had the opportunity to review the PSSA test and pursuant to Pennsylvania Code Title 22 Chapter 4, section 4.4 (d)(4) I am hereby exercising my right as a parent to have my child, [Name] excused from PSSA testing because of religious beliefs.
The Pennsylvania Department of Education explains this, see page 4, question 10 at Chapter 4 FAQ:
So, as long as a parent or guardian reviews the state assessment and provides a written statement providing his/her written objection for religious purposes (however vague that objection may be), the child must be excused from the assessment. PDE will not provide an opinion as to what is a proper religious objection.
The Pennsylvania Department of Education has made it clear that any objection to the testing materials for religious reasons must be specific in nature, must note the specific question or questions that are objectionable and the specific, religious reason for your objection. Please note a general statement of religious objection does not meet the intention of this review and will not be considered for possible exemption.