Teays Valley Mask Medical Exemption Form
All students in grades 3-12 are required to wear facial coverings during the school day. Further, all K-12 students are required to wear masks on the bus, while in the hallway or common areas, and in the classroom when appropriate physical distancing is not possible. A face shield may be used under certain circumstances as determined by the Superintendent.

Parents/Guardians can use this form to request a medical exemption from the District's facial covering policy. The Superintendent may grant or deny a request for a medical exemption from the District's facial covering policy. Further, the Superintendent (or his/her designee) may request further documentation justifying the medical exemption. These requests will be reviewed and a school nurse or their designee will follow up to let you know if the request has been approved or denied. Please allow 2-3 days for a response.
Email address *
Student First Name
Student Last Name
Parent/Guardian
Phone Number
Building
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My child requests an exemption from the District's facial covering policy:
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By checking this box, I acknowledge that I will provide the District with documentation verifying the medical reason for this request.
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I understand by checking this box that the Superintendent may grant or deny a request for an exemption from the District's facial covering policy. I understand that someone will follow up with me to let me know if my request has been approved or denied. This response may take 2-3 days.
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