Mask Exemption Waiver

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Please complete this form only if you are requesting a mask exemption waiver. In connection with the COVID-19 pandemic, the California Department of Public Health highly recommends students to wear face coverings while in attendance in-person at school to the extent required by applicable federal, state, local laws, regulations, ordinances, emergency orders. Valle Lindo School District recognizes that some students may have disabilities, medical conditions, personal beliefs or mental health conditions that prevent them from wearing a face covering. If your student meets one of the criteria above please complete this Mask Exemption Waiver Form.

Email *

Student's First & Last Name *

Student's Grade Level *

Homeroom Teacher's Name (If unknown, please leave blank)

Please select the reason you are applying for this waiver (check all that apply) *

Disability

Medical Condition

Mental Health

Personal Beliefs

Other

Required

Parent Consent: I assume all risks of any nature arising out of or in any way related to the Student’s face covering exemption at any school activity or facility and hold the school harmless from any liability or damages that may result from this requested mask exemption. If my child exhibits symptoms of COVID-19, tests positive for COVID-19, or is in close contact with someone who tests positive for COVID-19, I will immediately notify my child’s school. If my child exhibits symptoms of COVID-19, tests positive for COVID-19, or is in close contact with someone who tests positive for COVID-19, I understand that my child may be required to remain out of school for 5-10 or more days as directed by public health officials. I acknowledge this mask exemption waiver does not supersede a future public health order from the California Department of Public Health or Centers for Disease Control and Prevention. I request a mask exemption waiver for my student. Please provide your electronic signature below by typing your complete name on the line below. *

Student Electronic Signature *

Parent/Guardian Electronic Signature *

A copy of your responses will be emailed to the address you provided.

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