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

Para ver en español, oprima arriva en la parte dercha dondetiene la opcion de cambiar el idoma.
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Student First Name *
Student Last Name *
Grade *
Classroom Teacher *
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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