(comm-0020a) Mask Pass Form

Mask Pass Form

If your child wishes to receive a mask pass for the 2021-22 school year, the following form must be submitted. Your child’s school will distribute mask passes once the information is received and verified. Your child must keep the card on their person at all times. If they do not show the card when asked or forget their card at home, they will be asked to wear a mask.

Student Name *

Student ID Number *

Student Date of Birth * +

Does your student
take part in Athletics? *

School *

Grade *

Parent / Legal Guardian Name *

Parent/Guardian's Email *

Please upload proof of COVID-19 Vaccination. This must be one of the following:

Original or copy or a vaccination card indicating the student mentioned above completed a course of COVID-19 vaccination at least 14 days prior to uploading this information.

Print out or screen shot from the NMVaxView indicating the student mentioned above completed a course of COVID-19 vaccination at least 14 days prior to uploading this information.

Upload proof of Covid-19 vaccination

Admin use
only - test

y

n