Face Covering Opt-out

Face Covering Opt-out

Germantown Municipal School District
This form is only applicable to students enrolled in Germantown Municipal School District and does not apply to adult visitors to the building or staff members.

Adults are required to wear masks while on GMSD campuses during the school day.
Parent/Guardian Name*

First NameLast Name
Student Name*

First NameLast Name
Parent Email*
example@example.com
My child attends ________.*

Dogwood Elementary SchoolFarmington Elementary SchoolForest Hill Elementary SchoolRiverdale SchoolHouston Middle SchoolHouston High SchoolGermantown Online Academy of Learning
Per TN Governor Bill Lee's Executive Order No. 84, parents or guardians must submit their request for mask exemption in writing. We ask that you include your written statement in the text box below.

Sample Request:

I, (parent name), affirmatively notify the Germantown Municipal School District that my child, (student name) at (student's school) is opting out of wearing a face covering at school, on the school bus, or at school functions.

I recognize that this Executive Order ends on October 5, 2021 at 11:59pm.
Option 1: Type your formal request in the box below:
Option 2: Upload your formal request here.

Cancelof
Parent/Guardian Signature

Clear
Date Signed

Clear
Should be Empty: