Mask Break Opt-Out Form
Please fill out the form below if you would like to opt-out of provided mask breaks for your child during the school day. Please fill out one form per child.
Student First Name
Student Last Name
I understand that by placing my name (Parent First and Last Name) below I am consenting to my child NOT to have a mask break during the school day while in the traditional classroom setting.
Parent Phone Number
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This form was created inside of Madison Local School District.