Face Mask Requirement Opt-Out Consent Form

A school district form that lets a student's parent or guardian, or a school employee, formally opt out of the face-covering requirement while acknowledging the associated health guidance.

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Notice Regarding Face Covering Guidance

This form is filled for

Student Employee

Employee Name

Nombre

Apellido

Age of Student

Under 10 10-13 14-17 18 or older

Parent/Guardian Name

Nombre

Apellido

Phone Number

Email

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Student Name

Nombre

Apellido

Student ID

Date of Birth

Student Address

Dirección

Ciudad

Estado / Provincia

Código postal

I, undersigned, agree with the following statements:

I understand the associated health risks and choose to opt out of wearing a face covering

Date

Signature

Sign here

Face Mask Requirement Opt-Out Consent Form

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