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.

Use this template

In the Claude connectors directory

Notice Regarding Face Covering Guidance

This form is filled for

Student Employee

Employee Name

First Name

Last Name

Age of Student

Under 10 10-13 14-17 18 or older

Parent/Guardian Name

First Name

Last Name

Phone Number

Email

Address

Street Address

City

State / Province

ZIP / Postal Code

Student Name

First Name

Last Name

Student ID

Date of Birth

Student Address

Street Address

City

State / Province

ZIP / Postal Code

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

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