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.
Pediatricians and other health care providers may decide it is in their best interest to formally document a parent's refusal to accept vaccinations/immunizations for a minor child. This form, which should not be considered a legal document without advice from a lawyer, may be used for such documentation.
Request an affidavit via the Immunization Section Affidavit Request website. Please use the Microsoft Edge web browser when submitting a vaccine exemption request online. If requesting an Affidavit by Mail, send a written request for an affidavit through the United States Postal Service (USPS).
My religious beliefs and practices, which result in this request for a religious accommodation, are sincerely held. I understand that the accommodation requested above may not be granted but that the company will attempt to provide a reasonable accommodation that does not create an undue hardship on the company.
Objection to vaccination was also related to: faith in divine protection and healing for Protestants, Catholics, Jewish and Muslims (10); the use of aborted fetal cells for vaccines' production among Amish and Catholic communities (including during the COVID-19 outbreak when Senior Catholic leaders from the US and ...
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.
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.
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.
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.
You must request a vaccine exemption affidavit form by submitting a request through the U.S. Postal Service, commercial carrier, fax, or online. Phone and email requests are not accepted. Personal pick up at DSHS is not permitted. ALL affidavit forms will be mailed to you via the U.S. Postal Service.