Face Mask Exemption Form

Face Mask Exemption Request Form 

Please click the link below for the Face Mask Exemption Request Form.  This must be completely filled out including the certification form that must be signed by a physician.  All completed forms are to be sent to the Superintendent's Office.  Until we receive the form, signed by a physician and you are notified by the Superintendent's Office that the form has been approved, the student must wear a mask.      

You can mail or drop off the completed forms at the district office:

Pleasant Valley School District, Attn:  Superintendent, 2233 Route 115, Suite 100, Brodheadsville, PA 18322 or email franklin.kathleen@pvbears.org

Face Mask Exemption Request Form