Student Mask Survey/Safety Parent Permission
By order of the Secretary of the Pennsylvania Department of Health, all people are required to wear a face covering. However, a few exceptions are allowable. Please fill out this form answering questions to help us determine the need of each individual. :) Call Mrs. Cannon if you have questions.

Please note, that when students are spaced 6ft apart, it is not required for them to wear masks. Our goal is to keep students socially distanced as often as possible.

Students WILL be spaced out 6ft in the classroom. Elementary students will also be spaced 6ft when walking in the hallway for any transitions. We also will keep students spaced in the lunchroom.

MS/HS will be required to wear a mask in the hallway, when switching classes. However, in the classroom, students will be spaced 6ft apart.
Student Name (last, first) *
Student Grade *
My child CANNOT wear a mask due to a medical condition, mental health condition (i.e. stress, anxiety) or a disability. *
My child is UNABLE to take off and put on their mask without assistance. *
My child has communication needs (hearing disability/educational needs) and is unable to wear a mask. *
I understand that my middle & high school students WILL be required to wear a mask in the hallway, when switching classes. *
I would like my student to be masked as often as possible while in school. *
Please type your name below, which will serve as your signature for this form. *
Never submit passwords through Google Forms.
This form was created inside of Calvary Chapel Brownsville. Report Abuse