Juniata County School District

JCSD Face Covering Exception Request Form

I, __________________________________________, the parent of _______________________________, would like to request an exception to the Face Covering order listed below.

My child attends EJHS/EJES/JHS/TJHS/JES (circle one) and is in the __________ grade.

My child is exempt from the Pennsylvania Department of Health’s August 31, 2021, order requiring masks, under section 3 entitled Exceptions to Covering Requirement, subsection B.  Wearing a face covering would either cause a medical condition, or exacerbate an existing one, including respiratory issues that impede breathing, a mental health condition or a disability.

I recognize that although I have asserted subsection B of section 3 of the Pennsylvania Department of Health’s order entitled Exceptions to Covering Requirement my child’s condition only inhibits them from wearing a mask.

I will notify the Juniata County School District immediately if my child’s condition changes and requires additional reasonable accommodations.

Parent Signature:__________________________________________ 

Date:_______________________________