Mask Exemption Form

Last Updated: 9/9/2021 2:26 PM

Updated September 9, 2021

In order to be considered for a face cover exemption under Section 3B of the new masking Order, parents must fill out the district's exemption form.  Those who previously submitted an exemption form found on the internet must submit the district's exemption form as well.  In accordance with the Order, the District must substantiate the need for accommodations for your child under 22PA Code Chapter 15 and Section 504 of the Rehabilitation Act.  Please complete and sign the exemption form (1 form per child) and return to the building in which your attends.  Please accompany any medical documentation to substantiate the request if applicable.  This request is the initial step in requesting an accommodation for your child(ren) to not wear a mask.  Each family requesting an accommodation will follow the standard procedures in accordance with our 504 process.  For specific questions, please contact Julie Petrin, Director of Special Education.  Please note, until an exemption form is on file, students must wear a face covering.  Parents will be receiving paperwork from our Special Education Office within the next few days to initiate the 504 process.

Note:  The District has received a number of exemptions from Heritage Family Health and does not recognize this form as appropriate documentation for an exemption.  Documentation must be received their students' own PCP through the 504 process in order to be approved for an exemption.  Also, all other accommodations (i.e. alternate face coverings, additional mask breaks, etc.) must be exhausted prior to official approval of the exemption.

Mask Exemption Form

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