If the bona fide religious beliefs of an adult or the parent, guardian or person in loco parentis of a child are contrary to the immunization requirements, the adult or the child shall be exempt from the requirements. Upon submission of a written statement of the bona fide religious beliefs and opposition to the immunization requirements, the person may attend the college, university, school or facility without presenting a certificate of immunization. No child shall be exempt from the requirements of immunizations for the case of a personal belief or philosophy of a parent or guardian not founded upon a religious belief.
There's not a formal form although there are many examples out there. We wrote our exemption on a piece of paper and handed it to the registrar when we registered C and H for school. Apparently the schools (public) don't have a form either...they just require an informal statement. In fact, the woman wasn't interested in my pretty, notorized copy of a vaccine exemption letter.
Ashley~certified nurse-midwife mama to 6 little loves, including sweet Cordelia Jane born at home on 11/12/10.