The purpose of this form is to determine whether you may be eligible for an exception. I wish to obtain an Exemption from Immunizations for Reasons of Conscience Affidavit Form.Students may request a religious exemption if there is a conflict between the requirement to be vaccinated and sincerely held. I respectfully submit this statement of faith for a Constitutionally recognized and protected religious exemption against a mandatory injection. What information do I need to request an exemption? I have a sincerely held religious objection to the Covid vaccine and I am respectfully asserting my right to a religious exemption from this vaccine mandate.