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* 1. What school do you attend?

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* 2. Have facemasks ever hindered your physical well being or capabilities during school hours including after-school activities, ie. difficulty breathing, headaches, dizziness, blurred vision, shortness of breath, skin or eye irritation, increased heart rate, fatigue, trouble concentrating, recurring sickness, increased doctor visits, etc.?

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* 3. Have facemasks ever hindered your psychological well being or capabilities during school hours including after-school activities, ie. depression or worsened depression, bullied, demoralized, doubt its effectiveness, irritability or increased irritability, anxiety or increased anxiety, impaired mental clarity, feeling experimented on, increased therapists visits, etc.?

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* 4. Is the requirement to wear face masks to attend school the only reason you wear a mask at school?

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* 5. For VLI/Homeschool students: Is the requirement to wear face masks to attend school the only reason you opted out and are enrolled in VLI, homeschooling or other online education?

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* 6. Would you like to have your face mask tested by the Ohio Health Department to see what is found on it or them after an 8-hr school day? (If so, please provide me one of your child(ren)'s masks in a Ziplock bag for testing purposes with his/her name, date, school labeled with parent's authorizing signature on label.)

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* 7. If you have ever been quarantined, did you develop COVID symptoms while isolated at home? (Skip this question if you have never been quarantined.)

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* 8. Has your school prohibited you or threatened to prohibit you from attending school, including quarantining, expulsion or enrolling you in VLI, for any reason related to its COVID-19 face covering, testing and/or vaccinations policies?

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* 9. Does your parent want to stand up against these forced COVID-19 medical treatments: forced masking, testing, quarantines and/or vaccinations? (If so, have your parent(s) or guardian(s) sign this petition: https://www.ipetitions.com/petition/no-to-hcsd-covid-19-forced-medical-treatments.)

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* 10. Do you support mandating COVID-19 vaccinations for ALL children?

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