To claim a religious exemption, the parent or person requesting the exemption must write a statement of their religious objection to immunization. There is no form for requesting religious exemptions in North Carolina.We've provided a request form template for you to download and fill out here. This document is a religious exemption form for immunizations. It allows parents to opt-out of vaccinations for their children based on religious beliefs. I, __________________________________ am requesting a religious exemption from vaccination against the disease(s) or condition(s) marked below. To fill out this form, provide your identity details and submit your religious exemption statement. Religious exemption. Vaccine Religious Exemption (PDF) – If you require a religious exemption to any vaccines, download this form, complete it, and submit it through the portal. The South Carolina Certificate of Religious Exemption may only be obtained at a county public health department.