I respectfully submit this statement of faith for a Constitutionally recognized and protected religious exemption against a mandatory injection. The purpose of this form is to determine whether you may be eligible for an exception.Religious Exemption. For the religious exemption, this form must be notarized at the time of submission. Religious:If desired, attach a page with religious statement or a letter from your religious leader. â–¡ Good Cause: If desired, attach another page with reason(s). Learn how to request a vaccine exemption for personal, religious, or medical reasons. Two states, Louisiana and Minnesota, do not specify whether the nonmedical exemption must be for religious or personal reasons. Support For Exemption from COVID-19 Vaccination Requirement for Religious Beliefs. Of this exemption is false.