This form is a sample letter in Word format covering the subject matter of the title of the form.
This form is a sample letter in Word format covering the subject matter of the title of the form.
California removed its personal and religious exemption option in 2015. Parent/guradian must complete an online educational module to receive a non-medical exemption. Connecticut removed its religious exemption option in 2021.
The physician can register for an account in CAIR-ME and log in to issue the medical exemption​. Once the medical exemption is issued, the physician prints the form and provides a copy to the parents to give to their child's school or child care facility.
A religious exemption for daycare and school-aged children can be obtained through your local county health department.
I request to be exempted from the vaccine requirement on the basis of my bona fide religious belief, observance or practice. The following information is submitted in support of my request. (Please attach additional pages if needed.)
I, __________________________________ am requesting a religious exemption from vaccination against the disease(s) or condition(s) marked below. I understand that this exemption is allowed solely for sincerely held religious beliefs and not for political, social, or other personal views.
California removed its personal and religious exemption option in 2015. Parent/guradian must complete an online educational module to receive a non-medical exemption. Connecticut removed its religious exemption option in 2021.
All states allow exemptions for medical reasons, and almost all states (except California, Mississippi and West Virginia) grant religious or philosophical exemptions for people who have sincerely held beliefs that prohibit immunizations.
How to fill out the Pennsylvania Immunization Exemption Letter? Enter your name and address in the specified fields. Provide the date at the top of the letter. Clearly articulate your objection to immunization. Sign the letter as a parent or legal guardian. Submit the letter as required by Pennsylvania law.
California removed its personal and religious exemption option in 2015. Parent/guradian must complete an online educational module to receive a non-medical exemption. Connecticut removed its religious exemption option in 2021.