United States Vaccination Exemption Forms - Mothering Forums

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#1 of 3 Old 03-21-2010, 09:37 PM - Thread Starter
 
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This compilation was a group effort by many helpful MDC members. Thanks to everyone who contributed Please PM a Vaccinations forum moderator with any updates or additions.

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Here are the vaccine exemption forms and/or information for all 50 states:

If you're nosy, check out your state's exemption rates. http://www.msnbc.msn.com/id/26337586

Alabama
"A written objection from the parent or guardian of a student based on religious tenets and practices shall be submitted in person by the parent or guardian to the County Health Department for issuance of a Certificate of Religious Exemption from the required immunizations or testing."
http://www.adph.org/Immunization/ass...hoolImmLaw.pdf (1st page)

Alaska
Alaska Immunization Requirements Religious Exemption Form
http://www.epi.hss.state.ak.us/pubs/...Manual_v03.pdf
(go to page 52)

Alaska Immunization Requirements Medical Exemption Form
http://www.epi.hss.state.ak.us/pubs/...Manual_v03.pdf
(go to page 51)

Arizona
Child care centers
Request For Exemption to Immunization
http://azdhs.gov/als/forms/ccgh10.pdf

Arizona schools
Request for Exemption to Immunization
http://azdhs.gov/phs/immun/pdf/schoo...ption-form.pdf

Arkansas
http://www.healthyarkansas.com/rules...ments_2004.pdf (pages 4 and 5)

California
California School Immunization Record
http://www.cdph.ca.gov/pubsforms/for...rms/pm286b.pdf

Colorado
Childcare and schools
Colorado Department of Public Health and Environment -- Certificate of Immunization
http://www.cdphe.state.co.us/dc/Immu...-certofimm.pdf

Colorado colleges and universities
Certificate of Immunization for College Students
http://www.cdphe.state.co.us/dc/Immu...-collegeCI.pdf

Connecticut
Religious Exemption Certification Form
http://www.sde.ct.gov/sde/lib/sde/PD..._Exemption.pdf

Delaware
http://delcode.delaware.gov/title14/...tml#P227_51758 (contains exact wording for exemption affidavit)

District of Columbia
"No certification of immunization shall be required for the admission to a school of a student:
(1) For whom the responsible person objects in good faith and in writing, to the chief official of the school, that immunization would violate his or her religious beliefs; or (2) For whom the school has written certification by a private physician, his or her representative, or the public health authorities that immunization is medically inadvisable." (D.C. Code 38-506)

Florida
Immunization Guidelines Florida Schools, Childcare Facilities, and Family Daycare Homes
http://www.immunizeflorida.org/schoolguide.pdf
text of florida law regarding immunizations
http://www.doh.state.fl.us/Family/Sc...e/64D-3046.pdf
Form to opt out of "SHOTS" (State Health Online Tracking System)
http://www.flshots.org/_pdfs/OptOutDH-1478.pdf

Georgia
Childcare and schools
Immunization Guidelines for Child Care Facility Operators and School Personnel
http://health.state.ga.us/pdfs/preve...uctions.03.pdf (page 2)
"If there is a religious exemption, the parent/guardian must give the facility/school a signed and dated notarized statement or affidavit stating that immunizations are against their religious beliefs. This affidavit should be filed instead of the Certificate of Immunization. The affidavit does not expire."

Georgia colleges and universities
University System of Georgia Certificate of Immunization
http://www.usg.edu/student_affairs/f...n/coi-form.pdf

Hawaii
http://www.capitol.hawaii.gov/hrscur...0302A-1156.htm
http://hawaii.gov/health/family-chil...alth-faqs.html "Religious exemption forms may be completed at the school that your child will attend."

The Hawaii religious exemption form states, "I certify that immunization conflicts with my bona fide religious tenets and practices. I understand that my child is susceptible to vaccine preventable diseases. If at anytime there is, in the opinion of the Department of Health, danger of an outbreak or epidemic from any communicable disease for which immunization is required, this exemption shall not be recognized. I understand that my child will be excluded from school until the threat of an epidemic is over or he or she receives the proper immunization. (Hawaii Revised Statutes Section 302A-1157)"

Idaho
Idaho child care
State of Idaho Certificate of Exemption Child Care Immunization Requirement
https://iris.idaho.gov/irisweb/pdf/C...ExemptForm.pdf

Idaho schools
State of Idaho Certificate of Exemption
http://healthandwelfare.idaho.gov/Li...d=885&mid=2742

Note on Idaho exemption forms: You may not feel comfortable initialing those statements that you understand you are putting your child at risk. Idaho law does not require that you use those forms.
Idaho law for child care: http://www3.state.id.us/cgi-bin/newi...id=390110018.K
Idaho law for schools: http://www3.state.id.us/cgi-bin/newi...id=390480002.K

Illinois
law regarding exemptions http://www.ilga.gov/commission/jcar/...50000300R.html

Indiana
"A religious objection must be in writing and state that the objection to immunization is based on religious grounds; signed by the child’s parent; and delivered to the school. There is no requirement of proof. The written objection must be resubmitted to the school each year." https://chirp.in.gov/chirp_files/doc...008-2009V2.pdf

Iowa
Iowa Department of Public Health Certificate of Immunization Exemption
http://www.idph.state.ia.us/adper/co...munization.pdf

Kansas
Certificate of Immunizations
http://www.kdheks.gov/immunize/download/KCI_Form.pdf

Kentucky
Commonwealth of Kentucky Childhood Immunization Law Certificate of Religious Exemption (EPID-230C) http://www.owen.k12.ky.us/attendance...ERTIFICATE.doc

Louisiana
Louisiana Handbook for School Administrators
doa.louisiana.gov/osr/lac/28v115/28v115.doc
cut and paste the address above into your web browser.
(from page 29) "No student seeking to enter any school shall be required to comply with the provisions of this Section if the student or his parent or guardian submits either a written statement from a physician stating that the procedure is contraindicated for medical reasons, or a written dissent from the student or his parent or guardian is presented."

Maine
http://janus.state.me.us/legis/statu...-Asec6355.html

Maryland
Maryland Department of Health and Mental Hygiene Immunization Certificate http://edcp.org/pdf/896_form.pdf
Meningococcal waiver information for college http://edcp.org/html/meningupdate.html

Massachusetts
The parent or guardian should state "in writing that vaccination or immunization conflicts with his sincere religious beliefs."
http://www.mass.gov/legis/laws/mgl/76-15.htm

Michigan
Text of law regarding exemptions to vaccines: http://www.legislature.mi.gov/(S(yd3...e=mcl-333-9215
Official exemption form: http://www.momvaccines.org/miform.pdf
Alternate exemption form if you don't want to admit to putting your child at risk: http://www.momvaccines.org/momform.pdf
Opt-out form for the Michigan Care Improvement Registry (MCIR), which is a vaccine registry http://www.mcir.org/forms/OptOut%20Form%20Jan07.pdf

Minnesota
Submit a notarized statement that all or some immunizations are against your "conscientiously held beliefs." (Do not need to be religious beliefs).
http://www.health.state.mn.us/divs/i...exemption.html
Text of statute:
https://www.revisor.leg.state.mn.us/...es/?id=121A.15

Mississippi
Only allows medical exemptions to vaccines. They are very difficult to get. A physician (M.D. or D.O.) can request a medical exemption, but a government health official decides whether or not to grant it. Vaccines are not required for homeschooling.
http://www.msdh.state.ms.us/msdhsite...urces/2578.pdf
Text of statute:
http://www.mscode.com/free/statutes/41/023/0037.htm
If you want to work toward changing the law, here is the link to the Mississippi Vaccine Information Center.
http://parents.meetup.com/465/?success=details2

Missouri
http://www.sos.mo.gov/adrules/csr/cu...r/19c20-28.pdf

Montana
For a religious exemption, ask for the HES-113 form from the Department of Public Health and Human Services. It must be notarized every year.
http://mt.gov.cdc.nicusa.com/search?...DPHHS&oe=UTF-8

Nebraska

Refusal of Immunization of Student for Religious Reasons
http://dhhs.ne.gov/immunization/Religious_AFFIDAVIT.pdf

Nebraska
Refusal of Immunization for Medical Reasons
http://www.dhhs.ne.gov/immunization/...ON_medical.pdf

Nevada
"NRS 392.437 Immunization of pupils: Exemption if prohibited by religious belief. A public school shall not refuse to enroll a child as a pupil because the child has not been immunized pursuant to NRS 392.435 if the parents or guardian of the child has submitted to the board of trustees of the school district or the governing body of a charter school in which the child has been accepted for enrollment a written statement indicating that their religious belief prohibits immunization of such child or ward."
http://www.leg.state.nv.us/NRS/NRS-3...l#NRS392Sec437

New Hampshire
http://www.dhhs.state.nh.us/DHHS/IMM.../exemption.htm

New Jersey
http://www.state.nj.us/health/cd/chap14.htm

New Mexico
Certificate of Exemption From School/Daycare Immunization Requirements
http://www.immunizenm.org/documents/Exemption_new.pdf

New York
Request for Religious Exemption to Immunization Form
http://www.emsc.nysed.gov/sss/school...ormmarch10.pdf
(Many New York residents have had their requests for exemption denied. You need to research and be very careful about the wording before you submit the request).

North Carolina
vaccination exemption information
http://www.immunizenc.com/Exemptions.htm

North Dakota
Certificate of Immunization
http://www.ndhealth.gov/Immunize/Doc...Public/COI.pdf

Ohio
text of law: http://codes.ohio.gov/orc/3313.671 "A pupil who presents a written statement of the pupil’s parent or guardian in which the parent or guardian declines to have the pupil immunized for reasons of conscience, including religious convictions, is not required to be immunized."
Brochure about Ohio's immunization registry, and how to opt out: http://www.odh.ohio.gov/ASSETS/A3A45...A/impactsi.pdf

Oklahoma
http://www.ok.gov/health/Disease,_Pr...ool/index.html
http://www.oklahomahealthfreedom.org...ertificate.pdf (day care and school exemption form)
http://www.oklahomahealthfreedom.org/exemptions.html (college exemption information)

Oregon
Oregon Certificate of Immunization Status
http://oregon.gov/DHS/ph/imm/docs/SchCISform08.pdf
This is the brochure you are supposed to read before signing the religious exemption:
http://oregon.gov/DHS/ph/imm/docs/SchRelExempbrch.pdf

Pennsylvania
law regarding exemptions for child care http://www.pacode.com/secure/data/02...27/s27.77.html
law regarding exemptions for school http://www.pacode.com/secure/data/02...23/s23.84.html

Rhode Island
Daycare, preschools, and schools http://www.health.state.ri.us/immuni...ol-schools.pdf
Colleges and universities http://www.health.state.ri.us/immuni...University.pdf (page 5)S

South Carolina
A South Carolina Certificate of Religious Exemption may be obtained from the Department of Health and Environmental Control. (DHEC Form 1126) Here is a directory of offices. http://www.scdhec.net/health/countymap.htm. You must go in person to get the form. It must be notarized.

South Dakota
http://legis.state.sd.us/statutes/Di...1&Type=Statute

Tennessee
Religious Exemption from Vaccination
http://tennessee.gov/education/schoo...ormED-5379.pdf
text of statute
http://www.state.tn.us/tccy/tnchild/49/49-6-5001.htm

Texas
http://www.dshs.state.tx.us/immunize...htm#exclusions

Utah
Utah School and Early Childhood Program Immunization Guidebook 2008/2009.
http://www.immunize-utah.org/provide...ook%202008.pdf

Request to Withdraw from the Utah Statewide Immunization Information System
http://www.usiis.org/acrobat_files/Withdraw%20form.pdf

Vermont
School Immunization Exemption Form
http://healthvermont.gov/hc/imm/docu...ption_Form.pdf

Virginia
Certificate of Religious Exemption
http://www.vdh.virginia.gov/epidemio...ents/cre_1.pdf

Washington state
Certificate of Exemption (COE) From School, Child Care, and Preschool Immunization Requirements
http://www.doh.wa.gov/cfh/Immunize/d...fexemption.pdf

West Virginia
Only allows medical exemptions to vaccines
http://www.wvdhhr.org/immunizations/...ode_16_3_4.pdf
If you want to work toward changing the law, here is a link to "West Virginians for Vaccination Exemption"
http://www.wvve.info/index.html

Wisconsin
http://www.legis.state.wi.us/statutes/Stat0252.pdf (page 2) "The immunization requirement is waived if the student, if an adult, or the student’s parent, guardian or legal custodian submits a written statement to the school, day care center or nursery school objecting to the immunization for reasons of health, religion or personal conviction."

Wyoming
Rules and Regulations for School Immunizations: http://wdh.state.wy.us/familyhealth/...n/schools.html (Click on "Minimum Immunization Requirements) (2nd page)
Info on immunization registry and opting out: http://wdh.state.wy.us/familyhealth/...tion/WyIR.html (Click on "WyIR Opt Out Form")
MDC does not guarantee the accuracy of any of the information above so please verify with your local government and/or healthcare provider to confirm and discuss.

I have retired from administration work, so if you have a question about anything MDC-related, please contact Cynthia Mosher. Thanks!
 
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#2 of 3 Old 09-17-2013, 04:33 AM
 
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what can i find a exemption for new jersey ....its cant e viewed above

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#3 of 3 Old 09-17-2013, 05:55 PM
 
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Originally Posted by renizz View Post
 

what can i find a exemption for new jersey ....its cant e viewed above

 

http://www.state.nj.us/health/cd/documents/vaccine_qa.pdf

page 33 has information about the religious exemption.

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