CCCSA 2021-2022 Mask Opt-Out Form
Please fill out this form if you DO NOT wish for your student to be required to wear a mask while in the care of CCCSA.
You will need to complete one form for each student you are choosing to opt out of wearing a mask by Friday, August 13th, 2021.
The CDC recommends universal indoor masking for all teachers, staff, students, and visitors to K-12 schools, regardless of vaccination status. More information on the CDC guidance for COVID-19 prevention in K-12 schools can be found on the CDC website at
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Student First Name
Student Last Name
I am providing notice that my student will be opting out of district policies that require masks or face coverings.
Parent First Name
Parent Last Name
I attest that, to the best of my knowledge, the provided information is true and accurate and that I am the legal guardian of the student listed above.
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This form was created inside of Oasis High School.