Consent To Opt Out Of Face Mask Requirement Form

Consent To Opt Out Of Face Mask Requirement Form
According to DHEC and the Centers for Disease Control and Prevention (CDC), wearing of face coverings like mask slows the spread of COVID-19. The risk of contracting COVID-19 and spreading it to others increase when people aren't wearing a face covering.
On the other hand, students or employees may now opt-out of wearing a face coverings in public school districts as pursuant to Executive Order No. 2021-23 since May 11, 2021.
However, this exemption does not apply to bus transportation and requirements of face coverings will continue on all school buses under Federal Law.
Although the School District strongly encourages the use of face coverings, in conjunction with this order, the students or employees may opt-out of wearing face coverings by signing the agreement below.
This form is filled for
EmployeeStudent
Employee Name
First NameLast Name
Age of Student
Under 1818 and above
Parent/Guardian Name
First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Student Name
First NameLast Name
Student ID
Date of Birth
MonthDayYear
1
Student Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
I, undersigned, agree with the following statements:
I have signed this form freely and voluntarily.I acknowledge that DHEC and the CDC recommend that wearing face coverings in the school environment to protect against the spread of COVID-19 is based on scientific evidence.I hereby agree to release the District from any and all liability associated with my decision not to wear a face covering.I will notify the District in writing if I choose to revoke my consent.
Date
MonthDayYear
Date
Signature
Clear
Should be Empty: