Urbandale CSD Face Mask Exception Request
As the primary method of transmission for COVID-19 is through respiratory droplets, cloth masks are vital components to mitigate the spread of the virus. All Urbandale CSD staff, PreK-12 students, vendors, visitors, and spectators are still required to wear a cloth face mask (2-ply) while in district buildings and when riding a school bus. All mitigation strategies for Activities will also remain the same. If students or staff forget their mask, we will supply a 2-ply disposable mask. Masks must also be worn in outdoor settings where safe social distancing is unlikely, such as during recess.

Exceptions will be made for medical conditions or special circumstances. If your student has a medical condition or a special circumstance, please complete this form.
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Student's First and Last Name (complete one form per child)
School your child is attending for the 2020-21 school year.
Grade for 2020-21 School Year
Parent/Guardian's First and Last Name
Parent/Guardian Email Address
Parent/Guardian Phone Number
I would like to request that my child not wear a face mask due to the following: *
Please describe either your child's medical condition or special circumstance so your school nurse can have a better understanding of your child's health. *
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