Consent Form to Opt-Out of Face Mask Requirement By Deer Creek Public Schools
If a parent/legal guardian, eligible student, or Deer Creek employee/volunteer indicates that compliance with the mask requirement is not possible due to medical, religious, or a strong personal reason, completion of the following information is required in order to request an exemption.

If there is more than one person within a household, a separate consent form will need to be completed for each individual.
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School Site or Department *
Classification of individual requesting exemption *
LAST NAME of individual (student, staff, sub, or volunteer) receiving exemption *
FIRST NAME of individual receiving exemption *
Name of Parent/Legal Guardian (if student under 18)
Home address (including street, city, state, zip code)
Phone number (including area code)
Select type of exemption *
I am electing for my student (parent/guardian) or myself (employee or other) to opt-out of the mask requirement. *
By signing below (full first and last name), I attest that: (1) I have signed this form freely and voluntarily, and I am legally authorized to make decisions for the listed employee or student. (2) I understand and agree that nothing herein shall relieve the parent, guardian, employee, or student named from any liability associated with not wearing a face covering. (3) I agree on behalf of myself and/or the student to hereby release the school and Deer Creek Public Schools from any and all liability associated with not wearing a face covering. (4) I will notify the school (parents/guardians) or my supervisor (employees) in writing if I choose to revoke my consent. *
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