Student Mask Confirmation Form

If you would like Prairie's help supporting your family’s decision to have your child(ren) continue wearing a mask, please complete this form. It is also important that you make your child(ren) aware of your decision. Forms completed by 3:00 PM will be processed in time for the following school day.

Student Name*

Student Grade*

Parent or Guardian Name*

Parent or Guardian Daytime Phone Number*

Parent or Guardian Email*

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