Florida Mask Mandate Opt-Out Incident Report
Information collected here will be used to advocate for parental rights with the State Board of Education. Incident information may be shared with state leadership which could include contact information so they can reach out. If you are uncomfortable with your contact information being shared, please leave those sections blank.
Incident Type
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Student to student harassment
Staff to student harassment
Opt-out denied or mask use imposed despite opting out
Other parental rights issue
School District Name
Your answer
School where the incident took place
Your answer
Parent/Guardian Name
Your answer
Parent/Guardian Phone Number
Your answer
Parent/Guardian Email
Your answer
Grade of the child involved
Your answer
Date of Incident
Date
Approximate time of Incident
Time
:
AM
PM
Name of staff member involved
Your answer
Incident details (what happened)
Your answer
What action was taken by the school or administration following the incident?
Your answer
Is this the first incident?
Yes
No
Clear selection
Thank you for sharing your story. Together we can advocate for parental rights to be respected throughout Florida.
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