Complete this section ONLY if you belong to a church or religion that objects to the use of medical treatment. My state has this form where the parent will write out their religious reason for refusing vaccines and the physician is supposed to sign the bottom.I respectfully request an exemption from the Covid-19 Vaccination Requirement as it violates my sincerely held religious beliefs, practice, and observance. "I cannot thank you enough for your help, support and encouragement. I submitted my request for religious exemption to my human resources department today. We've provided a request form template for you to download and fill out here. This form is used to document a religious exemption from immunizations for students in Virginia. You must provide the school a signed, written statement expressing that you object to the required vaccinations based on religious grounds. Questions on exemptions from the mandate?