Diocese of Arlington – Mask Election Form

Governor Youngkin’s Executive Order Number Two (2022), effective January 24, 2022, provides:

The parents of any child enrolled in a[n] elementary or secondary school or a school based early childcare and educational program may elect for their children not to be subject to any mask mandate in effect at the child’s school or educational program.

No parent electing that a mask mandate should not apply to his or her child shall be required to provide a reason or make any certification concerning their child’s health or education.

Please use the form below indicate whether you elect for your child(ren) to wear, or not wear, a face mask while at school. If you later wish to change your election, please request and complete a new form. Use one line for each child enrolled at the school. Please print information clearly, and check one of the lines on the right (for “wear” or “not wear” a mask):

CDA Mask Election Form