Free Vaccine Exemption Forms
What Is a Vaccine Exemption Form?
A Vaccine Exemption Form is a declaration used mostly by parents or legal guardians to ask the government not to mandate their young children to take a vaccination or immunization.
Alternate Names:
- Vaccine Medical Exemption Form;
- Medical Vaccine Exemption Form.
There could be several crucial grounds as to why a parent or guardian may object to this kind of medical treatment. It might have a religious, psychological, or philosophical basis. The government or jurisdiction recognizes their choice, but parents must fill out this Vaccine Exemption Form and accept the conditions stated in it.
This form will include sections concerning the child's information, parental or caregiver information, listed name of vaccines, acknowledgement, disclaimer and release. The legal caregiver can decide whether or not their children should be excused from all vaccinations or only certain ones from those listed in the form of the available vaccinations. In addition, it inquires as to whether the waiver is a one off or on a continuous basis. The Vaccine Exemption Form template includes requests for the caregiver to explain their reasoning for the vaccine refusal.
For a full list of Vaccine Exemption Form templates please feel free to check out our library below.
How to Fill Out a Vaccine Exemption Form?
Filling out the Vaccine Exemption Form is quick and easy, particularly if you are aware of which information they will ask so that you can prepare everything beforehand. Below you can find a detailed guide on the information that will be required along with what you need to write in each section:
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Start by finding a suitable Vaccine Exemption Form template which can be edited for your convenience;
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Before you begin filling in the form, remember to use block capital letters when entering information and make sure that your handwriting is legible;
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Fill in the section about the legal guardian which includes their full name, relationship to the child, contact details (including telephone and email address) and an address;
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Information about the child is also required which includes their full name, date of birth and details about the school that they attend;
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You may also need to state the gender, ethnicity and race of the child;
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Below this you will find a list of vaccinations that the child requires and you should clearly mark on which vaccinations you do not wish your child to receive. You may tick one, several or all of them – this all depends on the circumstances and reasons for the exemption;
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Include the date that the exemption will be valid for and below this you will need to specify the reason for the exemption. In some cases, you may be asked to submit evidence along with the form;
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The parent or legal guardian should print their name, sign, and date the document;
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A notary public may be required to also validate the form and if so, they will need to provide their details, the date along with the notary seal. Only after this will the document have any legal weight.
Still looking for a particular form? Take a look at the related forms and templates below:
Documents:
41
This document is used for obtaining an exemption from immunization requirements in the state of Maine.
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This document is used for applying for an immunization exemption for Girl Scouts of Northern California in the state of California.
This Form is used for obtaining consent for immunizations required for students in New Mexico schools.
This form is used for claiming a personal or religious exemption from vaccination requirements in the state of Washington.
This Form is used for applying for a medical exemption for the influenza vaccination in the state of Washington.
This type of document can be used by a patient that has decided not to take a vaccine offered by the current physician or healthcare provider they visit.
This form is used to obtain a certificate of exemption from immunization requirements in Washington state. It is available in both English and Russian languages.
This document is used for obtaining a certificate of exemption from immunization requirements in Washington. It is available in both English and Punjabi languages.
This form is used for obtaining a certificate of exemption from immunization requirements in the state of Washington. It is available in both English and Spanish.
This form is used for obtaining a certificate of exemption from immunization requirements in Washington. It is available in both English and Chinese Simplified.
This Form is used for requesting an exemption from receiving the Sotrovimab vaccine in Nunavut, Canada.
This form is used for requesting exemption from Covid-19 vaccination in Florida based on Covid-19 immunity.
This form is used for individuals in Florida who claim religious exemption from receiving the Covid-19 vaccination.
This form is used for requesting exemptions from Covid-19 vaccination in Maryland based on medical and/or religious grounds.
This form is used for requesting a religious exemption to the Covid-19 vaccination in South Carolina.
This form is used for requesting a medical exemption from the Covid-19 vaccination in South Carolina.
This Form is used for applying for a Certificate of Exemption in the state of Washington. It is available in both English and Chuukese languages.
This form is used for requesting an exemption from receiving the Covid-19 vaccine in the state of Nebraska.
This Form is used for parents or guardians in Arizona to request an exemption from immunization for household members aged 13 and younger.
This form is used for requesting an exemption from immunization requirements for school entry in New Brunswick, Canada. It follows Policy 706.
This document is intended for individuals seeking exemption from the Covid-19 vaccination mandate based on religious beliefs. It outlines the process for filing such a request and the necessary information to provide.
This document is for the declination of getting the influenza vaccination. It provides an option to refuse or decline getting vaccinated against the flu.
This form is used for requesting a medical exemption from immunization in the state of Tennessee.
This form is used for parents to request an exemption from school immunization requirements based on medical, religious, or philosophical reasons.
This form is used for requesting a medical exemption for the Covid-19 vaccination in the state of Connecticut.
This Form is used for requesting a medical exception to the Covid-19 vaccination requirement.
This form is used for requesting a religious or spiritual exemption from receiving the Covid-19 vaccination in the state of Connecticut.
This form is used for religious exemption from certain requirements in Indiana.
This form is used for requesting an exemption from vaccination requirements in the state of Indiana. It allows individuals to provide a valid reason for not getting vaccinated, such as medical or religious beliefs.
This document is used by employees to request exemption from receiving the Covid-19 vaccine due to their religious beliefs. It contains specific guidelines to assist in making an informed and lawful decision.
This document is designed for individuals looking to file a request for religious exemption from mandatory Covid-19 vaccination due to their faith-based beliefs and practices.
This document is used by individuals seeking exemption from mandatory immunization due to religious beliefs. It contains a formal request to be excused, based on personal religious principles, from the necessity of receiving vaccinations.
This document is designed for individuals who are seeking an exception to the Covid-19 vaccination mandate due to personal grounds such as medical, religious or other issues. It outlines the process, privacy policies, and rights under the Privacy Act Statement.
This form is used for submitting proof of a medical exemption for immunization requirements in Montana schools, signed by a licensed physician.
This document is intended for residents of Connecticut seeking an exemption from vaccination due to religious beliefs. It gives guidelines on how to draft and submit a request for religious exemption.
