Mask Opt-Out Form November 2021

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* 1. Parent Name: (First and Last)

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* 2. Parent Email:

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* 3. Student #1: First and Last Name

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* 4. Student #1: Grade Level and Homeroom for 2021-2022 School Year

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* 5. Student #2: First and Last Name

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* 6. Student #2: Grade Level and Homeroom for 2021-2022 School Year

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* 7. Student #3: First and Last Name

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* 8. Student #3: Grade Level and Homeroom for 2021-2022 School Year

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* 9. Student #4: First and Last Name

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* 10. Student #4: Grade Level and Homeroom for 2021-2022 School Year

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* 11. Student #5: First and Last Name

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* 12. Student #5: Grade Level and Homeroom for 2021-2022 School Year

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