To be eligible for a possible exception, you must first establish that your refusal to be vaccinated is based upon a sincere belief that is religious in nature. To claim a religious exemption, workers' rights attorney Dana Wefer says a personal approach is best.You need to briefly explain your religious history and religious beliefs and why these beliefs prevent you from taking the COVID-19 vaccines. The religious exemption application form asks for a personal statement and a selfreported immunization history. Request for Religious or Medical Waiver Form. The template you will receive after completing the information below is only intended to be used as a template. Please put this information into your own words.